Gupta Ritu, Bajwa Sukhminder Jit Singh, Abraham John, Kurdi Madhuri
Department of Anaesthesia and Critical Care, Gian Sagar Medical College and Hospital, Patiala, Punjab, India.
Department of Anaesthesia and Critical Care, Christian Medical College, Ludhiana, Punjab, India.
Anesth Essays Res. 2020 Apr-Jun;14(2):295-299. doi: 10.4103/aer.AER_62_20. Epub 2020 Oct 12.
Stress hyperglycemia in critically ill patients has been a matter of debate for years without any conclusive answer till date regarding glucose management and treatment thresholds.
We planned a study with an aim to compare the efficacy of intensive versus conventional insulin therapy in reducing the mortality and morbidity in critically ill patients. The primary objective was to compare mortality between the two groups. The secondary objective was to find out if intensive insulin therapy is better than conventional insulin therapy in terms of various outcomes such as infections and need for inotropes and transfusion requirements.
It was a prospective randomized controlled study. The study population included 100 patients who received mechanical ventilation and admitted to the intensive care department of a tertiary care institute.
Patients were randomly assigned to two groups: intensive insulin therapy (IIT) and conventional insulin therapy (CIT) to receive either intensive or conventional insulin therapy. Insulin infusion was started only when blood glucose levels exceeded 200 mg%. Blood glucose levels were maintained between 80 and 110 mg% in the IIG and between 180 and 200 mg% in the CIG.
The data collected were analyzed separately for both the groups using Student's -test and Chi-square test.
The two groups were comparable in terms of baseline demographic data including age, sex, preadmission diabetic status, and HbA1c at the time of admission. The two groups were not comparable in terms of Acute Physiology and Chronic Health Evaluation-II scores, and the difference between them was statistically significant with higher scores in the conventional group. The primary outcome, that is, mortality, was higher in the CIG with 29 patients (58%) versus 3 (6%) in the IIG ( = 0.02). The secondary outcomes were the measures of morbidity including infections, need for inotropic support, and need for blood transfusions, and these were significantly higher in the conventional group ( < 0.05).
We conclude that tight glycemic control significantly lowers mortality and morbidity in critically ill patients, both surgical and medical. These benefits appear with the maintenance of tight blood glucose control of 80-110 mg.dL and not due to administration of insulin.
重症患者的应激性高血糖多年来一直是一个有争议的问题，迄今为止，关于血糖管理和治疗阈值尚无定论。
我们计划开展一项研究，旨在比较强化胰岛素治疗与传统胰岛素治疗在降低重症患者死亡率和发病率方面的疗效。主要目的是比较两组之间的死亡率。次要目的是了解强化胰岛素治疗在感染、使用血管活性药物需求和输血需求等各种结局方面是否优于传统胰岛素治疗。
这是一项前瞻性随机对照研究。研究人群包括100例接受机械通气并入住三级医疗机构重症监护病房的患者。
患者被随机分为两组：强化胰岛素治疗组（IIT）和传统胰岛素治疗组（CIT），分别接受强化或传统胰岛素治疗。仅当血糖水平超过200mg%时才开始胰岛素输注。强化胰岛素治疗组血糖水平维持在80至110mg%之间，传统胰岛素治疗组维持在180至200mg%之间。
使用学生t检验和卡方检验对两组收集的数据分别进行分析。
两组在包括年龄、性别、入院前糖尿病状态和入院时糖化血红蛋白等基线人口统计学数据方面具有可比性。两组在急性生理与慢性健康状况评分系统-II（APACHE-II）评分方面不具有可比性，传统组得分更高，差异具有统计学意义。主要结局即死亡率，传统胰岛素治疗组更高，有29例患者（58%），而强化胰岛素治疗组为3例（6%）（P = 0.02）。次要结局是发病率指标，包括感染、血管活性药物支持需求和输血需求，传统组这些指标显著更高（P < 0.05）。
我们得出结论，严格血糖控制可显著降低重症患者（包括外科和内科患者）的死亡率和发病率。这些益处出现在将血糖严格控制在80 - 110mg.dL的情况下，而非由于胰岛素的使用。
