tailieunhanh - Non-pulmonary Critical Care - part 7

Van Den Berghe et al, trong một nghiên cứu tiền cứu ngẫu nhiên, liên quan đến bệnh nhân, chứng minh rằng insulin điều trị chuyên sâu giảm tỷ lệ tử vong và bệnh tật trong số bệnh nhân nhập viện với một đơn vị chăm sóc phẫu thuật quan trọng | ENDOCRINEDISORDERS RAGHAVAN MARIK 277 critical illness thereby counteracting the protein catabolism that occurs during critical INTENSIVE INSULIN THERAPY IN THE CRITICALLY ILL Van Den Berghe et al in a prospective randomized controlled study involving 1548 patients demonstrated that intensive insulin therapy reduced mortality and morbidity among patients admitted to a surgical critical care unit the Leuven Intensive Insulin Therapy Trial .1 46 These authors compared an intensive insulin therapy regimen aimed to maintain blood glucose between 80 and 110 mg dL with conventional treatment in which insulin infusion was only initiated when glucose level was greater than 215 mg dL and maintenance of glucose between 180 and 200 mg dL. At 12 months the mortality was with the intensive insulin regimen compared with in the control group. The benefit was most apparent in patients with greater than 5 days of stay in the intensive care unit. Tight and early glycemic control was associated with the more rapid improvement of insulin Intensive insulin therapy was associated with reduced bloodstream infections by 46 acute renal failure by 41 and critical illness polyneuropathy by 44 . Using multivariate analysis the authors suggested that improved metabolic control as reflected by normoglycemia rather than the infused insulin dose per se was responsible for the beneficial effects of intensive insulin therapy. However achieving normoglycemia and the administration of insulin are linked and from the available evidence it appears likely that both factors played a key role in the improved outcome. The outcome data from the Leuven Intensive Insulin Therapy Trial indicates that there is a direct relationship between the degree of glycemic control and hospital In the long-stay patients 5 days in the ICU the cumulative hospital mortality was 15 in patients with a mean blood glucose less than 110 mg dL 25 in those with a blood glucose between