Insulin Therapy and In‐Hospital Mortality in Critically Ill Patients: Systematic Review and Meta‐analysis of Randomized Controlled Trials

Pittas, Anastassios G.; Siegel, Richard D.; Lau, Joseph

doi:10.1177/0148607106030002164

Cited by 151 publications

(124 citation statements)

References 62 publications

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“…Over the past decade a growing body of literature has linked adverse outcomes and hyperglycemia in the critically ill patient [28,29]. Recent large randomized trials have demonstrated a beneficial effect of IIT in terms of clinically important morbidity and mortality endpoints [12,16].…”

Section: Discussionmentioning

confidence: 99%

Early versus late intravenous insulin administration in critically ill patients

Honiden

Schultz

et al. 2008

Intensive Care Med

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Objective-To investigate whether timing of intensive insulin therapy (IIT) after intensive care unit (ICU) admission influences outcome.Design and setting-Single-center prospective cohort study in the 14-bed medical ICU of a 1,171-bed tertiary teaching hospital.Patients-The study included 127 patients started on ITT within 48 h of ICU admission (early group) and 51 started on ITT thereafter (late group); the groups did not differ in age, gender, race, BMI, APACHE III, ICU steroid use, admission diagnosis, or underlying comorbidities.Measurements and results-The early group had more ventilator-free days in the first 28 days after ICU admission (median 12 days, IQR 0-24, vs. 1 day, 0-11), shorter ICU stay (6 days, IQR 3-11, vs. 11 days, vs. 7-17), shorter hospital stay (15 days, IQR 9-30, vs. 25 days, 13-43), lower ICU mortality (OR 0.48), and lower hospital mortality (OR 0.27). On multivariate analysis, early therapy was still associated with decreased hospital mortality (OR adj 0.29). The strength and direction of association favoring early IIT was consistent after propensity score modeling regardless of method used for analysis.Conclusions-Early IIT was associated with better outcomes. Our results raise questions about the assumption that delayed administration of IIT has the same benefit as early therapy. A randomized study is needed to determine the optimal timing of therapy.

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Section: Discussionmentioning

confidence: 99%

Early versus late intravenous insulin administration in critically ill patients

Honiden

Schultz

et al. 2008

Intensive Care Med

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“…No major adverse clinical outcomes related to the use of SWGD have been noted in these infants. The recent observations of poor outcomes associated with hyperglycemia in ELBW infants 22 and pediatric patients 27 and the improved outcomes reported with more aggressive treatment of hyperglycemia in critically ill adults 28,29 suggest that a more aggressive approach for the prevention and treatment of hyperglycemia, which might include SWGD, warrants investigation in ELBW infants. Although our trial did not demonstrate the hypothesized benefit of SWGD, it represents a methodologically sound evaluation of the potential usefulness, or lack thereof, of a therapy that may be widespread in NICUs.…”

Section: Discussionmentioning

confidence: 99%

Randomized trial of sterile water by gavage drip in the fluid management of extremely low birth weight infants

Stewart¹,

Morris

Huseby³

et al. 2008

J Perinatol

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Objective: To determine whether extremely low birth weight infants who receive enteral sterile water have a reduction in treated patent ductus arteriosus or death by 28 days compared to infants with routine management.Study Design: A total of 214 infants were enrolled and randomized by 36 h of age to receive up to 50 ml kg À1 per day of enteral sterile water (n ¼ 109) for 7 days or routine fluid management (n ¼ 104). Patent ductus arteriosus treatment was defined as either indomethacin treatment or surgical ligation.Result: The proportion of infants with a treated patent ductus arteriosus or death at <28 days of age was 63% in the sterile water group vs 64% in the control group (relative risk 0.99, 95% confidence interval 0.81 to 1.22). There were no differences in the proportion of infants in the sterile water group vs control group with a treated patent ductus arteriosus (55 vs 48%), death (21 vs 28%), necrotizing enterocolitis or death (24 vs 32%), or bronchopulmonary dysplasia or death at <28 days (80 vs 77%). Daily mean glucose levels were significantly higher (P ¼ 0.04) in control infants than sterile water infants. Conclusion:The use of sterile water did not decrease the incidence of patent ductus arteriosus or other adverse clinical outcomes. The role of enteral sterile water in the fluid management of extremely low birth weight infants remains uncertain.

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“…Blood sugar starts to rise slowly and insulin production from the pancreas is inhibited (Boffard 2003;Winkler & Manchester 1996). A metaanalysis of randomised controlled trials (RCT) on insulin therapy administration during critical illness showed that hyperglycemia is common in patients with critical illness and also may play a role in the activation of the tissue factor pathway of coagulation (Pittas, Siegel & Lau 2004). This may lead to the development of acute thrombosis.…”

Section: Correspondence Tomentioning

confidence: 99%

Exercise overcomes muscle weakness following on trauma and critical illness

Aswegen

Myezwa

2008

South African Journal of Physiotherapy

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Injuries related to trauma are often seen in South Africanintensive care units. Systemic inflammation and the development of sepsislead to prolonged intensive care unit and hospital stay. The effects of critical illness and immobility on the human body are not always well-understood. This review article explains the pathogenesis of muscle weak-ness due to inflammation and identifies the role of exercise prescription incounteracting impairments that may be identified in survivors of traumaduring and after hospital stay.

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Insulin Therapy and In‐Hospital Mortality in Critically Ill Patients: Systematic Review and Meta‐analysis of Randomized Controlled Trials

Abstract: Insulin therapy in adult patients hospitalized for a critical illness, other than hyperglycemic crises, may decrease mortality in certain groups of patients.

Cited by 151 publications

References 62 publications

Early versus late intravenous insulin administration in critically ill patients

Early versus late intravenous insulin administration in critically ill patients

Randomized trial of sterile water by gavage drip in the fluid management of extremely low birth weight infants

Exercise overcomes muscle weakness following on trauma and critical illness

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