Background Hyperglycemia and insulin resistance are common in critically ill patients, even if they have not previously had diabetes. Whether the normalization of blood glucose levels with insulin therapy improves the prognosis for such patients is not known. Methods We performed a prospective, randomized, controlled study involving adults admitted to our surgical intensive care unit who were receiving mechanical ventilation. On admission, patients were randomly assigned to receive intensive insulin therapy (maintenance of blood glucose at a level between 80 and 110 mg per deciliter) or conventional treatment (infusion of insulin only if the blood glucose level exceeded 215 mg per deciliter and maintenance of glucose at a level between 180 and 200 mg per deciliter). Results At 12 months, with a total of 1548 patients enrolled, intensive insulin therapy reduced mortality during intensive care from 8.0 percent with conventional treatment to 4.6 percent (P<0.04, with adjustment for sequential analyses). The ...

https://www.nejm.org/doi/pdf/10.1056/NEJMoa011300

Intensive Insulin Therapy in Critically Ill Patients

Acute kidney injury

Objective To investigate the relationship between hyperglycemia and hospital mortality in a heterogeneous group of critically ill patients. Patients and Methods Retrospective data were reviewed for 1826 consecutive patients whose glucose values were obtained during their intensive care unit stay at The Stamford Hospital in Stamford, Conn, between October 1, 1999, and April 4, 2002. Results Mean and maximum glucose values were significantly higher among nonsurvivors than among survivors for the entire group ( P Conclusion Even a modest degree of hyperglycemia occurring after intensive care unit admission was associated with a substantial increase in hospital mortality in patients with a wide range of medical and surgical diagnoses. Analysis of glucose values added predictive power above that achieved by APACHE II scores alone. These results have important implications for the glycemic management of critically ill patients.

https://www.mayoclinicproceedings.org/article/S0025-6196(11)62743-2/pdf

Association Between Hyperglycemia and Increased Hospital Mortality in a Heterogeneous Population of Critically Ill Patients

ContextHyperglycemia is common in critically ill patients, even in those without
diabetes mellitus. Aggressive glycemic control may reduce mortality in this
population. However, the relationship between mortality, the control of hyperglycemia,
and the administration of exogenous insulin is unclear.ObjectiveTo determine whether blood glucose level or quantity of insulin administered
is associated with reduced mortality in critically ill patients.Design, Setting, and PatientsSingle-center, prospective, observational study of 531 patients (median
age, 64 years) newly admitted over the first 6 months of 2002 to an adult
intensive care unit (ICU) in a UK national referral center for cardiorespiratory
surgery and medicine.Main Outcome MeasuresThe primary end point was intensive care unit (ICU) mortality. Secondary
end points were hospital mortality, ICU and hospital length of stay, and predicted
threshold glucose level associated with risk of death.ResultsOf 531 patients admitted to the ICU, 523 underwent analysis of their
glycemic control. Twenty-four–hour control of blood glucose levels was
variable. Rates of ICU and hospital mortality were 5.2% and 5.7%, respectively;
median lengths of stay were 1.8 (interquartile range, 0.9-3.7) days and 6
(interquartile range, 4.5-8.3) days, respectively. Multivariable logistic
regression demonstrated that increased administration of insulin was positively
and significantly associated with ICU mortality (odds ratio, 1.02 [95% confidence
interval, 1.01-1.04] at a prevailing glucose level of 111-144 mg/dL [6.1-8.0
mmol/L] for a 1-IU/d increase), suggesting that mortality benefits are attributable
to glycemic control rather than increased administration of insulin. Also,
the regression models suggest that a mortality benefit accrues below a predicted
threshold glucose level of 144 to 200 mg/dL (8.0-11.1 mmol/L), with a speculative
upper limit of 145 mg/dL (8.0 mmol/L) for the target blood glucose level.ConclusionsIncreased insulin administration is positively associated with death
in the ICU regardless of the prevailing blood glucose level. Thus, control
of glucose levels rather than of absolute levels of exogenous insulin appear
to account for the mortality benefit associated with intensive insulin therapy
demonstrated by others.

https://jamanetwork.com/journals/jama/articlepdf/197458/JCE20070.pdf

Glucose Control and Mortality in Critically Ill Patients

Sarcopenia is a loss of muscle protein mass and loss of muscle function. It occurs with increasing age, being a major component in the development of frailty. Current knowledge on its assessment, etiology, pathogenesis, consequences and future perspectives are reported in the present review. On-going and future clinical trials on sarcopenia may radically change our preventive and therapeutic approaches of mobility disability in older people.

/pdf/sarcopenia-its-assessment-etiology-pathogenesis-consequences-44lsxabedh.pdf

Sarcopenia: Its assessment, etiology, pathogenesis, consequences and future perspectives

Background The administration of growth hormone can attenuate the catabolic response to injury, surgery, and sepsis. However, the effect of high doses of growth hormone on the length of stay in intensive care and in the hospital, the duration of mechanical ventilation, and the outcome in critically ill adults who are hospitalized for long periods is not known. Methods We carried out two prospective, multicenter, double-blind, randomized, placebo-controlled trials in parallel involving 247 Finnish patients and 285 patients in other European countries who had been in an intensive care unit for 5 to 7 days and who were expected to require intensive care for at least 10 days. The patients had had cardiac surgery, abdominal surgery, multiple trauma, or acute respiratory failure. The patients received either growth hormone (mean [±SD] daily dose, 0.10±0.02 mg per kilogram of body weight) or placebo until discharge from intensive care or for a maximum of 21 days. Results The in-hospital mortality rate was higher...

Guy Vundelinckx

Papers

Increased mortality associated with growth hormone treatment in critically ill adults.