Department of General Intensive Care, University Hospital Centre of Liege, Liege, Belgium.
Curr Opin Clin Nutr Metab Care. 2010 Mar;13(2):205-10. doi: 10.1097/MCO.0b013e328335720b.
Intensive insulin therapy titrated to restore and maintain blood glucose between 80 and 110 mg/dl (4.4-6.1 mmol/l) was found to improve survival of critically ill patients in one pioneering proof-of-concept study performed in a surgical intensive care unit. The external validity of these findings was investigated.
Six independent prospective randomized controlled trials, involving 9877 patients in total, were unable to confirm the survival benefit reported in the pioneering trial. Several hypotheses were proposed to explain this discrepancy, including the case-mix, the features of the usual care, the quality of glucose control and the risks associated with hypoglycemia.
Before a better understanding and delineation of the conditions associated with and improved outcome by tight glycemic control, the choice of an intermediate glycemic target appears as a safe and effective solution.
在一项开创性的外科重症监护病房研究中，将血糖滴定至 80-110mg/dl（4.4-6.1mmol/l）以恢复和维持血糖的强化胰岛素治疗被发现可改善危重症患者的生存率。本研究旨在调查这些发现的外部有效性。
六项独立的前瞻性随机对照试验，共涉及 9877 例患者，无法证实开创性试验报告的生存率获益。提出了几种假设来解释这种差异，包括病例组合、常规治疗的特征、血糖控制的质量以及与低血糖相关的风险。
在更好地了解和确定与严格血糖控制相关的条件以及改善预后之前，选择中间血糖目标似乎是一种安全有效的解决方案。
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