tailieunhanh - Báo cáo y học: "Does intensive insulin therapy really reduce mortality in critically ill surgical patients? A reanalysis of meta-analytic data."

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: Does intensive insulin therapy really reduce mortality in critically ill surgical patients? A reanalysis of meta-analytic data. | Friedrich et al. Critical Care 2010 14 324 http content 14 5 324 CRITICAL CARE VIEWPOINT L_ Does intensive insulin therapy really reduce mortality in critically ill surgical patients A reanalysis of meta-analytic data Jan O Friedrich - 2-3 Clarence Chant4 and Neill KJ Adhikari -5 Abstract Two recent systematic reviews evaluating intensive insulin therapy IIT in critically ill patients grouped randomized controlled trials RCTs by type of intensive care unit ICU . The more recent review found that IIT reduced mortality in patients admitted to a surgical ICU- but not in those admitted to medical ICUs or mixed medical-surgical ICUs or in all patients combined. Our objective was to determine whether IIT saves lives in critically ill surgical patients regardless of the type of ICU. Pooling mortality data from surgical and medical subgroups in mixed-ICU RCTs 6 trials with RCTs conducted exclusively in surgical ICUs five trials and in medical ICUs five trials respectively-showed no effect of IIT in the subgroups of surgical patients risk ratio 95 confidence interval CI to .04- P 0. p 5 - 95 CI to 75 or of medical patients risk ratio .02- 95 CI to .09- P I2 0 - 95 CI 0 to 4 . There was no differential effect between subgroups interaction P 0. 0 . There was statistical heterogeneity in the surgical subgroup- with some trials demonstrating significant benefit and others demonstrating significant harm- but no surgical subgroup consistently benefited from IIT. Such a reanalysis suggests that IIT does not reduce mortality in critically ill surgical patients or medical patients. Further insights may come from individual patient data meta-analyses or from future large multicenter RCTs in more narrowly defined subgroups of surgical patients. Correspondence 2Critical Care and Medicine Departments- St Michael s Hospital- 30 Bond StreetBond Wing- Room 4-0 5 Bond- Toronto- Ontario- Canada M5B W8 Full list of author .