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Intensive Care Medicine
Published in: Intensive Care Medicine 5/2007

01-05-2007 | Original

Failure to achieve glycemic control despite intensive insulin therapy in a medical ICU: incidence and influence on ICU mortality

Authors: Jean-Claude Lacherade, Patricia Jabre, Sylvie Bastuji-Garin, David Grimaldi, Pascal Fangio, Valerie Théron, Hervé Outin, Bernard De Jonghe

Published in: Intensive Care Medicine | Issue 5/2007

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Abstract

Objective

Intensive insulin therapy reduces mortality in subgroups of intensive care unit (ICU) patients, and awareness of the importance of blood glucose level (BGL) control has increased among ICU physicians and nurses. The impact of insulin treatment strategies on mortality may be influenced by their efficacy in achieving the target BGL range. We assessed the efficacy of an insulin treatment strategy in maintaining BGL within the target range, and we compared ICU mortality in patients who did and did not reach the BGL target.

Design

Prospective cohort study.

Setting

12-bed medical ICU in a tertiary teaching hospital.

Patients and participants

Adults consecutively admitted over a 9-month period to an ICU where standard care included an insulin treatment strategy aimed at maintaining BGL ≤ 7 mmol/l.

Measurements and main results

105 patients were included. Median SAPS II was 45 (31–54). Failure to control BGL (mean capillary BGL > 7 mmol/l after initial hyperglycemia correction) occurred in 32 patients (31.1%) and was associated with a significant increase in ICU mortality (56.2 vs. 23.3% in patients with successful BGL control). In the multivariate analysis, failure to control BGL independently predicted death in the ICU (OR 5.9, 2.1–16.6, p < 0.001).

Conclusions

Failure to control BGL despite intensive insulin therapy was common and independently associated with ICU mortality. Failure to control BGL may considerably affect the overall impact of insulin treatment strategies on mortality.
Appendix
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Metadata
Title
Failure to achieve glycemic control despite intensive insulin therapy in a medical ICU: incidence and influence on ICU mortality
Authors
Jean-Claude Lacherade
Patricia Jabre
Sylvie Bastuji-Garin
David Grimaldi
Pascal Fangio
Valerie Théron
Hervé Outin
Bernard De Jonghe
Publication date
01-05-2007
Publisher
Springer Berlin Heidelberg
Published in
Intensive Care Medicine / Issue 5/2007
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-007-0543-0

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