Effect of an Intensive Glucose Management Protocol on the Mortality of Critically Ill Adult Patients

Krinsley, James S.

doi:10.4065/79.8.992

Cited by 1,104 publications

(665 citation statements)

References 35 publications

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“…The reduction in mortality rate in this study was due primarily to decreased multiple organ failure related to sepsis. The results of this study (henceforth referred to as the Leuven I study) are compared in Table 1 with the other four largest studies [4][5][6][7], including a second study by Van den Berghe and colleagues (Leuven II) in medical ICU patients [7], addressing the question of the impact of glycaemic control on outcomes in the critically ill and in which a glycaemic target was part of the study design. Two of these studies were observational, using historical controls [5,6].…”

Section: The Results Of Five Large Studiesmentioning

confidence: 99%

“…The results of this study (henceforth referred to as the Leuven I study) are compared in Table 1 with the other four largest studies [4][5][6][7], including a second study by Van den Berghe and colleagues (Leuven II) in medical ICU patients [7], addressing the question of the impact of glycaemic control on outcomes in the critically ill and in which a glycaemic target was part of the study design. Two of these studies were observational, using historical controls [5,6]. The difference in mortality rate between the two study groups of Leuven II was significant only when those with ICU stays of 3 days or less were considered separately, but the participants in this study were more critically ill and had by far the highest mortality rate of the five studies.…”

Section: The Results Of Five Large Studiesmentioning

confidence: 99%

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No, the glycaemic target in the critically ill should not be ≤6.1 mmol/l

2007

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Section: The Results Of Five Large Studiesmentioning

confidence: 99%

Section: The Results Of Five Large Studiesmentioning

confidence: 99%

No, the glycaemic target in the critically ill should not be ≤6.1 mmol/l

2007

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“…Treatment of hyperglycaemia in surgical patients in the Intensive Care Unit (ICU) consistently shows improved results in that complications are avoided [199][200][201][202]. Any reduction in hyperglycaemia, regardless of the degree or level, improves outcomes.…”

Section: Postoperative Control Of Glucosementioning

confidence: 99%

Guidelines for Perioperative Care in Elective Colonic Surgery: Enhanced Recovery After Surgery (ERAS^®) Society Recommendations

et al. 2012

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Background This review aims to present a consensus for optimal perioperative care in colonic surgery and to provide graded recommendations for items for an evidencedbased enhanced perioperative protocol. Methods Studies were selected with particular attention paid to meta-analyses, randomised controlled trials and large prospective cohorts. For each item of the perioperative treatment pathway, available English-language literature was examined, reviewed and graded. A consensus recommendation was reached after critical appraisal of the literature by the group. Results For most of the protocol items, recommendations are based on good-quality trials or meta-analyses of goodquality trials (quality of evidence and recommendations according to the GRADE system). Conclusions Based on the evidence available for each item of the multimodal perioperative care pathway, the Enhanced

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“…It was matched by the retrospective study of Krinsley [32]. A later study by Van den Berghe et al [33] was less successful with a more dynamic medical ICU cohort.…”

Section: Hyperglycemia Hypoglycemia Tgc and Patient Mortality Outcomementioning

confidence: 99%

Tight glycemic control in critical care – The leading role of insulin sensitivity and patient variability: A review and model-based analysis

Chase

Compte

Suhaimi

et al. 2011

Computer Methods and Programs in Biomedicine

123

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Tight glycemic control (TGC) has emerged as a major research focus in critical care due to its potential to simultaneously reduce both mortality and costs. However, repeating initial successful TGC trials that reduced mortality and other outcomes has proven difficult with more failures than successes. Hence, there has been growing debate over the necessity of TGC, its goals, the risk of severe hypoglycemia, and target cohorts.This paper provides a review of TGC via new analyses of data from several clinical trials, including SPRINT, Glucontrol and a recent NICU study. It thus provides both a review of the problem and major background factors driving it, as well as a novel model-based analysis designed to examine these dynamics from a new perspective. Using these clinical results and analysis, the goal is to develop new insights that shed greater light on the leading factors that make TGC difficult and inconsistent, as well as the requirements they thus impose on the design and implementation of TGC protocols.A model-based analysis of insulin sensitivity using data from three different critical care units, comprising over 75,000 hours of clinical data, is used to analyse variability in metabolic dynamics using a clinically validated model-based insulin sensitivity metric (S I ). Variation in S I provides a new interpretation and explanation for the variable results seen (across cohorts and studies) in applying TGC. In particular, significant intra-and inter-patient variability in insulin resistance (1/ S I ) is seen be a major confounder that makes TGC difficult over diverse cohorts, yielding variable results over many published studies and protocols. Further factors that exacerbate this variability in glycemic outcome are found to include measurement frequency and whether a protocol is blind to carbohydrate administration.

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Effect of an Intensive Glucose Management Protocol on the Mortality of Critically Ill Adult Patients

Cited by 1,104 publications

References 35 publications

No, the glycaemic target in the critically ill should not be ≤6.1 mmol/l

No, the glycaemic target in the critically ill should not be ≤6.1 mmol/l

Guidelines for Perioperative Care in Elective Colonic Surgery: Enhanced Recovery After Surgery (ERAS^®) Society Recommendations

Tight glycemic control in critical care – The leading role of insulin sensitivity and patient variability: A review and model-based analysis

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Effect of an Intensive Glucose Management Protocol on the Mortality of Critically Ill Adult Patients

Cited by 1,104 publications

References 35 publications

No, the glycaemic target in the critically ill should not be ≤6.1 mmol/l

No, the glycaemic target in the critically ill should not be ≤6.1 mmol/l

Guidelines for Perioperative Care in Elective Colonic Surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations

Tight glycemic control in critical care – The leading role of insulin sensitivity and patient variability: A review and model-based analysis

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Product

Resources

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Guidelines for Perioperative Care in Elective Colonic Surgery: Enhanced Recovery After Surgery (ERAS^®) Society Recommendations