tailieunhanh - Báo cáo y học: "Tight glycemic control: what do we really know, and what should we expec"

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: Tight glycemic control: what do we really know, and what should we expect? | Nasraway Jr and Rattan Critical Care 2010 14 198 http content 14 5 198 CRITICAL CARE COMMENTARY L__ Tight glycemic control what do we really know and what should we expect Stanley A Nasraway Jr and Rishi Rattan See related research by Chase etal. http content 14 4 R154 Abstract Tight glycemic control has engendered large numbers of investigations with conflicting results. The world has largely embraced intensive insulin as a practice but applies this therapy with great variability in the manner of glucose control and measurement. The present commentary reviews what we actually know with certainty from this vast sea of literature and what we can expect looking forward. In the previous issue of Critical Care Chase and colleagues present retrospective historically controlled data from 784 critically ill patients treated with tight glycemic control target glucose 4 to 6 mmol l using the Specialised Relative Insulin and Nutrition Titration SPRINT protocol 1 . They report achieving faster resolution of organ failure. This observation dovetails with the Leuven I trial 2 and early studies 3 4 that first showed reductions in the incidence of renal and respiratory failure but conflicts with other more recent trials demonstrating no difference in organ failure when using intensive insulin 5-10 . The main advantages of SPRINT are that the protocol aims for relatively strict euglycemia the protocol is conservative in application the protocol maintains eugly-cemia with less variability the protocol concomit antly adjusts for caloric intake using a handheld device protocol for insulin dosing and the protocol requires frequent blood glucose monitoring. The first report on SPRINT indicated lower hospital mortality rates and less hypoglycemia in long-stay protocol patients 11 . What does this mean for the reader and bedside clinician in the intensive care unit ICU Correspondence Snasraway@ Department of Surgery Tufts Medical .