Endocrine Critical Care

Intensive insulin therapy:

van den Berghe G, Wilmer A, Hermans G, et al. Intensive insulin therapy in the medical ICU. N Engl J Med. 2006; 354:449-61. RCT of 1200 MICU patients found those randomized to intensive therapy had reduced risk of acute renal injury and shorter duration of ICU stay, but no difference in mortality. Of note, patients with ICU stays < 3 days had higher mortality than controls while those with stays > 3 days had reduced mortality with intensive control.
PMID: 16452557
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Finfer S, Chittock DR, Su SY, et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med 2009; 360:1283-97. The NICE-SUGAR trial randomized 6,104 MICU and SICU patients with anticipated ICU stay of > 3 days to tight (81 – 108 mg/dl) or conventional (144 - 180 mg/dl) glucose control and found 90-day mortality of 27.5% with tight control vs. 24.9% with conventional (p = 0.02). The groups did not differ in secondary outcomes including duration of hospital and ICU stay or need for dialysis. In contrast, previous studies by the van den Berghe group targeted a glucose of under 215 mg/dl in the control group, had greater use of parenteral nutrition, and were performed at a single center.
PMID: 19318384
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***See also Steroids in Sepsis/Septic Shock