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Mortality in Critically Ill Patients Reduced 29% With Target Glucose of <140 mg/dL
Posted: Thursday, March 04, 2004
Twelve months after initiating an intensive glucose management program using a blood glucose target of less than 140 mg/dL, absolute mortality was reduced by 6.1%, while the relative risk compared to historical controls was reduced by 29.3%, according to results of a study in a 14-bed mixed medical/surgical intensive care unit.
James Krinsley, MD, director of critical care at the Stamford Hospital, Stamford, Connecticut, United States, presented data from 800 patients admitted since the initiation of the glucose control protocol and 800 historical controls. He presented the findings February 24th, 2004 at the 33rd Critical Care Congress, the Annual Meeting of the Society of Critical Care Medicine.
Many intensive care units have been attempting to institute intensive glycemic management protocols in response to the 2001 New England Journal of Medicine publication of a study by Greet Van den Berghe et al that found that controlling glucose to a goal of 110 mg/dL or less reduced in-hospital mortality by 34%, reduced blood stream infections by 46%, cut dialysis days by 41%, cut the red-cell transfusion rate in half, and reduced the time on mechanical ventilation.
But, Dr. Krinsley said that translating Van den Berghe's experience to real world critical care is difficult since it is labor intensive and most units are not set up to accommodate the additional nursing time.
The Stanford Hospital is a Columbia University affiliated community hospital and its ICU is a 14-bed unit that has more than 1,800 admissions annually. The goal of the protocol was to maintain blood glucose at less than 140 mg/dL. Glucose was obtained at admission and patients were monitored with frequent finger sticks. If glucose was 200 mg/dL or higher at 2 successive finger sticks, the patients were put on intravenous insulin and there was intensive regular insulin coverage, he said.
The demographics between the glycemic control protocol patients and the controls were similar: about half were men, 75% were white, and the average age was 69. The mean APACHE II score in the glycemic control patients was 15 while the mean score in the control group was 16. A little more than 60% of patients came from the medical service, and the breakdown for the protocol patients was: 142 neuro patients, 175 cardiology patients, 45 patients with septic shock, 125 respiratory, and 117 "other medical" patients. An additional 150 patients were admitted from general surgery and there were 46 trauma patients.
The in-hospital mortality was 14.8% while in-hospital mortality for the controls was 20.9%, he said. "There were 12 cases of new renal insufficiency in the controls and 3 in the treatment group, which was significant," he said. Among controls 25.2% of patients required packed red blood cell (PRBC) transfusions, "and in the treatment group we reduced transfusions to 20.5%, that is a relative reduction of 18.7% in red blood cell transfusions and it was significant," he said.
[Study title: Decreased Mortality of Critically Ill Patients with The Use Of An Intensive Glycemic Management Protocol. Oral Abstract 72]
Source: Diabetes in Control.com.
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