tailieunhanh - Báo cáo y học: "Clinical review: Strict or loose glycemic control in critically ill patients - implementing best available evidence from randomized controlled trials"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Clinical review: Strict or loose glycemic control in critically ill patients - implementing best available evidence from randomized controlled trials. | Schultz et al. Critical Care 2010 14 223 http content 14 3 223 CRITICAL CARE REVIEW L_ Clinical review Strict or loose glycemic control in critically ill patients - implementing best available evidence from randomized controlled trials Marcus J Schultz - 2 Robin E Harmsen -2 and Peter E Spronk -3 Abstract Glycemic control aiming at normoglycemia frequently referred to as strict glycemic control SGC decreased mortality and morbidity of adult critically ill patients in two randomized controlled trials RCTs . Five successive RCTs however failed to show benefit of SGC with one trial even reporting an unexpected higher mortality. Consequently- enthusiasm for the implementation of SGC has declined hampering translation of SGC into daily ICU practice. In this manuscript we attempt to explain the variances in outcomes of the RCTs of SGC and point out other limitations of the current literature on glycemic control in ICU patients. There are several alternative explanations for why the five negative RCTs showed no beneficial effects of SGC apart from the possibility that SGC may indeed not benefit ICU patients. These include but are not restricted to variability in the performance of SGC differences among trial designs changes in standard of care differences in timing that is initiation of SGC and the convergence between the intervention groups and control groups with respect to achieved blood glucose levels in the successive RCTs. Additional factors that may hamper translation of SGC into daily ICU practice include the feared risk of severe hypoglycemia additional labor associated with SGC and uncertainties about who the primarily responsible caregiver should be for the implementation of SGC. Background Strict glycemic control SGC decreased mortality and morbidity of ICU patients in two randomized controlled Correspondence Department of Intensive Care Academic Medical Center University of Amsterdam Meibergdreef 9 05 AZ Amsterdam the