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01-02-2014 | Seven-Day Profile Publication

Tight computerized versus conventional glucose control in the ICU: a randomized controlled trial

Authors: Pierre Kalfon, Bruno Giraudeau, Carole Ichai, Alexandre Guerrini, Nicolas Brechot, Raphaël Cinotti, Pierre-François Dequin, Béatrice Riu-Poulenc, Philippe Montravers, Djilalli Annane, Hervé Dupont, Michel Sorine, Bruno Riou, On behalf of the CGAO–REA Study Group

Published in: Intensive Care Medicine | Issue 2/2014

Abstract

Purpose

The blood glucose target range and optimal method to reach this range remain a matter of debate in the intensive care unit (ICU). A computer decision support system (CDSS) might improve the outcome of ICU patients through facilitation of a tighter blood glucose control.

Methods

We conducted a multi-center randomized trial in 34 French ICU. Adult patients expected to require treatment in the ICU for at least 3 days were randomly assigned without blinding to undergo tight computerized glucose control with the CDSS (TGC) or conventional glucose control (CGC), with blood glucose targets of 4.4–6.1 and <10.0 mmol/L, respectively. The primary outcome was all-cause death within 90 days after ICU admission.

Results

Of the 2,684 patients who underwent randomization to the TGC and CGC treatment groups, primary outcome was available for 1,335 and 1,311 patients, respectively. The baseline characteristics of these treatment groups were similar in terms of age (61 ± 16 years), SAPS II (51 ± 19), percentage of surgical admissions (40.0 %) and proportion of diabetic patients (20.3 %). A total of 431 (32.3 %) patients in the TGC group and 447 (34.1 %) in the CGC group had died by day 90 (odds ratio for death in the TGC 0.92; 95 % confidence interval 0.78–1.78; p = 0.32). Severe hypoglycemia (<2.2 mmol/L) occurred in 174 of 1,317 patients (13.2 %) in the TGC group and 79 of 1,284 patients (6.2 %) in the CGC group (p < 0.001).

Conclusions

Tight computerized glucose control with the CDSS did not significantly change 90-day mortality and was associated with more frequent severe hypoglycemia episodes in comparison with conventional glucose control.

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Available at: http://cran.r-project.org/. Last date accessed November 2013.

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Title: Tight computerized versus conventional glucose control in the ICU: a randomized controlled trial
Authors: Pierre Kalfon
Bruno Giraudeau
Carole Ichai
Alexandre Guerrini
Nicolas Brechot
Raphaël Cinotti
Pierre-François Dequin
Béatrice Riu-Poulenc
Philippe Montravers
Djilalli Annane
Hervé Dupont
Michel Sorine
Bruno Riou
On behalf of the CGAO–REA Study Group
Publication date: 01-02-2014
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 2/2014
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-013-3189-0

At a glance: The STEP trials

Springer Medicine

Tight computerized versus conventional glucose control in the ICU: a randomized controlled trial

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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