Randomized, Double-Blind, Placebo-Controlled Trial of Effects of Enteral Iron Supplementation on Anemia and Risk of Infection during Surgical Critical Illness

Pieracci, Fredric M.; Henderson, Peter W.; Rodney, J.R.; Holena, Daniel N.; Genisca, Alicia E.; Ip, Ivan K.; Benkert, S.; Hydo, Lynn J.; Eachempati, Soumitra R.; Shou, Jian; Barie, Philip S.

doi:10.1089/sur.2008.043

Cited by 69 publications

(44 citation statements)

References 43 publications

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“…The only study of treatment of iron deficiency in critically ill patients is that of Pieracci et al, which explores enteral iron supplementation (ferrous sulfate 325 mg three times daily). 25 In the study, oral iron was associated with a reduction in the transfusion rate in patients with baseline iron deficiency and no increased risk of infection. Iron may thus be proposed to correct iron deficiency and/or enhance response to ESA in critically ill patients, but additional studies are needed to rule out the potential risks of iron treatment (i.e., oxidative stress induction, increased risk of infection).…”

Section: What Are the Implications For The Treatment Of Anemia In Crimentioning

confidence: 89%

Hepcidin and Anemia of the Critically Ill Patient

et al. 2011

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Section: What Are the Implications For The Treatment Of Anemia In Crimentioning

confidence: 89%

Hepcidin and Anemia of the Critically Ill Patient

et al. 2011

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“…In 863 patients postcardiopulmonary bypass surgery, treated with both intravenous iron and erythropoietin as needed, or with blood transfusions, there was no difference in subsequent infection rate (102). In a trial of 200 patients receiving care in a surgical ICU (103), randomization to enteral ferrous sulfate (vs. placebo) failed to produce any statistically significant difference in hematocrit, iron markers, infection rates, antibiotic days, hospital length of stay, or mortality. Notably, patients given iron were significantly less likely to receive a blood transfusion (29.9 vs. 44.7%; P ¼ 0.03) as compared with the placebo group.…”

Section: Iron Therapymentioning

confidence: 98%

Anemia in Critical Illness

Hayden

Albert

Watkins

et al. 2012

Am J Respir Crit Care Med

210

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Anemia is common in the intensive care unit, and may be associated with adverse consequences. However, current options for correcting anemia are not without problems and presently lack convincing efficacy for improving survival in critically ill patients. In this article we review normal red blood cell physiology; etiologies of anemia in the intensive care unit; its association with adverse outcomes; and the risks, benefits, and efficacy of various management strategies, including blood transfusion, erythropoietin, blood substitutes, iron therapy, and minimization of diagnostic phlebotomy.

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“…Many drugs, depending on the enzymatic reaction, may interfere with the blood glucose measurement (eg, ascorbic acid, acetaminophen, icodextrin) [22]. The main culprit in the accuracy of the blood glucose meters during critical illness appears to be anemia [23], which is widely tolerated in critically ill patients due to restrictive transfusion policies [24,25]. Anemia mainly results in overestimation of glycemia, leading to overtreatment with insulin and finally inducing hypoglycemia [26].…”

Section: Is Nice-sugar Evidence Against Blood Glucose Control?mentioning

confidence: 99%

Glycemic Targets and Approaches to Management of the Patient with Critical Illness

Mesotten

Berghe

2011

Curr Diab Rep

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Hyperglycemia during critical illness is associated with adverse outcome. The proof-of-concept Leuven studies assessed causality, and revealed that targeting strict normoglycemia (80-110 mg/dL) with insulin improved outcome compared with tolerating hyperglycemia to the renal threshold (215 mg/dL). A large multicenter trial (NICE-SUGAR [Normoglycaemia in Intensive Care Evaluation and Survival Using Glucose Algorithm Regulation]) found an intermediate blood glucose target (140-180 mg/dL) safer than targeting normoglycemia. Differences in design and in execution of glycemic control at the bedside may have contributed to these results. In NICE-SUGAR (Normoglycaemia in Intensive Care Evaluation and Survival Using Glucose Algorithm Regulation), the blood-glucose target range in the control group was lower, there were problems to reach and maintain normoglycemia in the intervention group, and inaccurate handheld blood glucose meters and variable blood sampling sites were allowed. Inaccurate tools led to insulin-dosing errors with consequently (undetected) hypoglycemia and unacceptable blood glucose variability. Also, the studies were done superimposed upon different nutritional strategies. Thus, such differences do not allow simple, evidence-based recommendations for daily practice, but an intermediate blood glucose target may be preferable while awaiting better tools to facilitate safely reaching normoglycemia.

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Randomized, Double-Blind, Placebo-Controlled Trial of Effects of Enteral Iron Supplementation on Anemia and Risk of Infection during Surgical Critical Illness

Cited by 69 publications

References 43 publications

Hepcidin and Anemia of the Critically Ill Patient

Hepcidin and Anemia of the Critically Ill Patient

Anemia in Critical Illness

Glycemic Targets and Approaches to Management of the Patient with Critical Illness

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