Background The optimal target range for blood glucose in critically ill patients remains unclear. Methods Within 24 hours after admission to an intensive care unit(ICU), adults who were expected to require treatment in the ICU on 3 or more consecutive days were randomly assigned to undergo either intensive glucose control, with a target blood glucose range of 81 to 108 mg per deciliter(4.5 to 6.0 mmol per liter), or conventional glucose control, with a target of 180 mg or less per deciliter(10.0 mmol or less per liter). We defined the primary end point as death from any cause within 90 days after randomization. Results Of the 6104 patients who underwent randomization, 3054 were assigned to undergo intensive control and 3050 to undergo conventional control; data with regard to the primary outcome at day 90 were available for 3010 and 3012 patients, respectively. The two groups had similar characteristics at baseline. A total of 829 patients(27.5%) in the intensive-control group and 751(24.9%) in the conventional-control group died(odds ratio for intensive control, 1.14; 95% confidence interval, 1.02 to 1.28; P=0.02). The treatment effect did not differ significantly between operative(surgical) patients and nonoperative(medical) patients(odds ratio for death in the intensive-control group, 1.31 and 1.07, respectively; P = 0.10). Severe hypoglycemia(blood glucose level, <40 mg per deciliter>[2.2 mmol per liter]) was reported in 206 of 3016 patients(6.8%) in the intensive-control group and 15 of 3014(0.5%) in the conventional-control group(P<0.001). There was no significant difference between the two treatment groups in the median number of days in the ICU(P = 0.84) or hospital(P = 0.86) or the median number of days of mechanical ventilation(P = 0.56) or renal-replacement therapy(P=0.39). Conclusions In this large, international, randomized trial, we found that intensive glucose control increased mortality among adults in the ICU: a blood glucose target of 180 mg or less per deciliter resulted in lower mortality than did a target of 81 to 108 mg per deciliter.(ClinicalTrials.gov number, NCT00220987.)
In critically ill patients, intensive glucose control leads to moderate and severe hypoglycemia, both of which are associated with an increased risk of death. The association exhibits a dose-response relationship and is strongest for death from distributive shock. However, these data cannot prove a causal relationship. (Funded by the Australian National Health and Medical Research Council and others; NICE-SUGAR ClinicalTrials.gov number, NCT00220987.).
evere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 , now characterized as a pandemic by the World Health Organization. 1 Infection rates and deaths worldwide increased exponentially. About 35 000 confirmed cases and more than 1600 deaths were reported in Canada as of Apr. 21, 2020. 2 In British Columbia, as of May 20, 2020, there were 2467 confirmed cases and 149 deaths. 3 However, the number of new cases has been decreasing since the beginning of April 2020. More than 85% of the cases of COVID-19 in BC have been located in the Metro Vancouver area. 3 Initial studies from China 4 and Italy 5 showed mortality ranging from 26% to 62% in critically ill patients with COVID-19. Studies from Seattle 6 and New York 7 reported overall mortality ranging from 23% to 50%. In these case series, between 13% and 71% of patients remained in the intensive care units (ICUs) at the time of publication, so actual mortality may be greater than reported.Canadian data describing critically ill patients with COVID-19 are lacking, and better characterization is crucial to direct critical care resource allocation and to understand the disease in our local context. The aim of our multicentre case series was to describe the demographic characteristics, management patterns and outcomes among critically ill patients with COVID-19 in Metro Vancouver. MethodsWe conducted a case series of all patients with COVID-19 admitted to an ICU in the Metro Vancouver area from Feb. 21 to Apr. 14, 2020, with outcomes followed until May 5, 2020. This area serves about 3 million residents of BC (population 4.9 million). The hospitals included were Vancouver General Hospital (46 ICU beds, quaternary hospital), Surrey Memorial Hospital (46 ICU beds, tertiary hospital), Lions Gate Hospital (11 ICU beds, community hospital),
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