thE rolE of insUlin in thE critically ill patiEnts

with intensive insulin therapy; P=0.005). The greatest reduction in mortality involved deaths due to multiple-organ failure with a proven septic focus. Intensive insulin therapy also reduced overall in-hospital mortality by 34%, bloodstream infections by 46%, acute renal failure requiring dialysis or hemofiltration by 41%, the median number of red cell transfusions by 50%, and critical-illness polyneuropathy by 44%, and the patients receiving intensive therapy were less likely to require prolonged mechanical ventilation and intensive care. Krinsley2 in his retrospective study of more than 1800 critically ill medical and surgical patients, consecutively admitted to the ICU at the Stamford Hospital, Stamford, Conn, revealed that patients with increasing level of hyperglycemia have progressively greater mortality. This observation by Krinsley reflects a broader patient population than the predominantly cardiac surgical Van den Berghe et al reported. Cardiothoracic surgical ICU patient were not included in Krinsley’s patient database, and his study included almost twice the number of known diabetic patients compared with the Van den Berghe et al study. BenefIcIAl effects of InsulIn In cRItIcAlly Ill pAtIents control of hyperglycemia Control of blood sugar by exogenous insulin at a level between 80-100 mg/dl significantly improves the prognosis as reported by Van den Berghe et al in his land mark study. Anti-inflammatory and antioxidant Insulin suppresses the production and harmful action of tumor necrosis factor A, macrophage, migration inhibitory factor and free radical as reported by Das UN.3