tailieunhanh - Báo cáo khoa học: " Insulin and metabolic substrates during human sepsis"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Insulin and metabolic substrates during human sepsis. | Available online http content 8 4 227 Commentary Insulin and metabolic substrates during human sepsis Simon J Finney Unit of Critical Care National Heart and Lung Institute Imperial College London UK Corresponding author Simon J Finney Published online 25 May 2004 This article is online at http content 8 4 227 2004 BioMed Central Ltd Related to Research by Rusavy et al. see page 292 Critical Care 2004 8 227-228 DOI cc2883 Abstract Rusavy and colleagues recently endeavoured to dissect out the metabolic effects of insulin in patients with severe sepsis in the setting of normoglycaemia. Twenty stable patients were studied 3-7 days after admission using a euglycaemic clamp at two supraphysiological insulin levels. Increased doses of exogenous insulin caused preferential use of glucose as a metabolic substrate while total energy expenditure remained constant. Consequently hyperinsulinaemia reduced tissue oxygen demand and catabolism of protein in patients with sepsis the benefits of these effects are not proven. The effects of insulin at different time points in sepsis were not examined. Keywords glucose insulin metabolic response severe sepsis The landmark study of intensive insulin therapy conducted by van den Berghe and colleagues 1 highlighted to critical care physicians the vital importance of the metabolic substrate-insulin axis in critically ill patients. An impressive absolute reduction in intensive care unit mortality was achieved in predominantly surgical patients managed with insulin to achieve a blood glucose level of mmol l 80-110 mg dl as compared with a control target range of mmol l 180-200 mg dl . Thus it is clear that blood glucose levels exceeding mmol l 180 mg dl are unacceptable in such patients although the merits of further increasing doses of exogenous insulin by either supplying additional substrate or aiming to achieve tighter glycaemic control have been debated