A phase II randomised controlled trial of intensive insulin therapy in general intensive care patients.
نویسندگان
چکیده
OBJECTIVE To determine the safety and efficacy of an intensive insulin regimen compared with a conventional insulin regimen in general intensive care unit patients. METHODS A phase II, randomised controlled trial was conducted in 70 critically ill patients in a closed multidisciplinary ICU of a university-affiliated tertiary hospital. We assessed patient characteristics at baseline. Trial process measures included number of blood glucose measurements per day and number in target range, type and quantity of caloric intake, patient outcome and insulin dosing. The primary outcome was the median blood glucose concentration. Secondary outcome measures were incidence of hypoglycaemia (blood glucose level < 2.2 mmol/L), clinical sequelae of hypoglycaemia and hospital mortality. RESULTS Thirty-five patients were randomised to each of the two groups. More blood glucose samples were taken per day in the intensive insulin group (16 versus 9), but the number of samples in the normoglycaemic range was 48.5%, compared with 79.8% within the target glucose range in the conventional insulin group. The median (interquartile range) blood glucose concentrations in the intensive and conventional insulin therapy groups were 5.4 (5.1-5.7) mmol/L and 7.9 (7.2-9.0) mmol/L, respectively (difference, 2.5 mmol/L; P < 0.0001). Five patients (14.3%) in the intensive insulin therapy group became hypoglycaemic versus none in the conventional insulin therapy group. There were no detected clinical sequelae of hypoglycaemia. CONCLUSION The intensive insulin regimen was effective in achieving the target blood glucose concentration, with clear separation from the conventional insulin regimen. Although the incidence of hypoglycaemia was increased, there was no detectable harm.
منابع مشابه
Supplemental parenteral nutrition in critically ill patients: a study protocol for a phase II randomised controlled trial
BACKGROUND Nutrition is one of the fundamentals of care provided to critically ill adults. The volume of enteral nutrition received, however, is often much less than prescribed due to multiple functional and process issues. To deliver the prescribed volume and correct the energy deficit associated with enteral nutrition alone, parenteral nutrition can be used in combination (termed "supplementa...
متن کاملThe Impact of an ICU Liaison nurse Program on Physiological Parameter and Level of Consciousness in Discharging Patients in the Intensive Care Unit: A Randomized Clinical Trial
Introduction: Patients transferred from ICU to general ward need a higher level of nursing attention and care than other patients admitted to the ward. The aim of this study was to investigate the effect of the role of the liaison nurse on physiological indicators and the level of consciousness of patients transferred from the intensive care unit. Methods: The present article is the result of...
متن کاملIntensive care unit randomised trial comparing two approaches to oxygen therapy (ICU-ROX): results of the pilot phase.
OBJECTIVE The objective of the intensive care unit randomised trial comparing two approaches to oxygen therapy (ICU-ROX) pilot phase, which included the first 100 patients of an overall sample of 1000, was to examine feasibility. DESIGN Investigator-initiated, prospective, parallel-group, pilot randomised controlled trial. SETTING Six medical-surgical intensive care units (ICUs) in Australi...
متن کاملOutcome of Critically ill Patients Undergoing Mandatory Insulin Therapy Compared to Usual Care Insulin Therapy: Protocol for a Pilot Randomized Controlled Trial
BACKGROUND Observational and interventional studies in patients with both acute medical conditions and long-standing diabetes have shown that improved blood glucose control confers a survival advantage or reduces complication rates. Policies of "tight" glycaemic control were rapidly adopted by many general intensive care units (ICUs) worldwide in the mid 00's, even though the results of the stu...
متن کاملIntensive insulin therapy in severely burned pediatric patients: a prospective randomized trial.
RATIONALE Hyperglycemia and insulin resistance have been shown to increase morbidity and mortality in severely burned patients, and glycemic control appears essential to improve clinical outcomes. However, to date no prospective randomized study exists that determines whether intensive insulin therapy is associated with improved post-burn morbidity and mortality. OBJECTIVES To determine wheth...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
عنوان ژورنال:
- Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine
دوره 8 4 شماره
صفحات -
تاریخ انتشار 2006