1027 More on tight glycaemic control in the ICU

Previous summaries have commented on studies and meta-analyses that have examined the benefits and risks of tight glycaemic control in the ICU (see 0411 and 0909). Insulin appears to have a role in recovery and repair, and insulin resistance appears to be a factor after various forms of stress and trauma. In a recent major study in a Belgian paediatric ICU, tight control resulted in significantly shorter ICU stays as well as lower mortality. Additional data have emerged for neonates undergoing heart surgery, again showing apparent benefits of insulin therapy. Fourteen neonates were studied, based on the hypothesis that insulin-titrated tight glycaemic control initiated prior to myocardial ischaemia and reperfusion would protect the myocardium and attenuate inflammatory responses after cardiac surgery. This was a randomized controlled study, and while numbers were small, the results again support insulin treatment in this group of patients. Tight control significantly reduced circulating levels of cardiac troponin-I (p=0.009), heart fatty acid-binding protein (p=0.01), B-type natriuretic peptide (p=0.02) and interleukin-8 (p=0.05), and also reduced post-operative increases in C-reactive protein. The authors conclude that intra- and post-operative tight glycaemic control protects the myocardium and reduces the inflammatory response, and that the response appears to be mediated by preventing hyperglycaemia during reperfusion rather than being mediated by an early, direct insulin signaling effect.

Read more:
Ann Thorac Surg 2010; 90: 22-9
Lancet 2009; 373: 547-56
Crit Care Med 2009; 37: 1769-76