Tight blood glucose control with insulin in the ICU: facts and controversies.

Department of Intensive Care Medicine, Katholieke Universiteit Leuven, Leuven, Belgium.
Chest (Impact Factor: 7.13). 08/2007; 132(1):268-78. DOI: 10.1378/chest.06-3121
Source: PubMed

ABSTRACT Recently, the concept that stress hyperglycemia in critically ill patients is an adaptive, beneficial response has been challenged. Two large randomized studies demonstrated that maintenance of normoglycemia with intensive insulin therapy substantially prevents morbidity and reduces mortality in these patients. Since then, questions have been raised about the efficacy in general and in specific subgroups, and about the safety of this therapy with regard to potential harm of brief hypoglycemic episodes and of high-dose insulin administration. These issues are systematically addressed in relation to the available evidence. Intensive insulin therapy during intensive care is effective in reducing the mortality and morbidity of critical illness. The available randomized studies show that an absolute reduction in risk of hospital death of 3 to 4% is to be expected from this therapy in an intention-to-treat analysis. In order to confirm this survival benefit and assign it as statistically significant, future studies should be adequately powered, and hence sample size should be at least 5,000. The absolute reduction in the risk of death increases to approximately 8% when patients are treated with intensive insulin for at least 3 days. Data available thus far indicate that blood glucose control to strict normoglycemia is required to obtain the most clinical benefit. The risk of hypoglycemia increases with this therapy, but it remains unclear whether this is truly harmful in the setting of critical care.

  • [Show abstract] [Hide abstract]
    ABSTRACT: We report a facile approach for the synthesis of homochiral 1,2-disubstituted ferrocene-functionalized Lewis acids and acid/base pairs. The synthesis is based on chiral induction facilitated by the ortho sulfinyl subsitutent in S-Fc{S(O)p-tol}, S-1, to obtain the key intermediate S,Sp-1,2-fc{S(O)p-tol}(BMes2), S,Sp-2a (p-tol = C6H4Me-4, Mes = C6H2Me3-2,4,6). Subsequent substitution of the –S(O)p-tol substituent in S,Sp-2a gives access to a range of enantiomerically pure Sp-1,2-ferrocene-functionalized Lewis acids and acid/base pairs including the first homochiral 1-phosphino-2-borylferrocene. Enantiomeric excesses (e.e.s) of >95% have typically been achieved using this methodology.
    Journal of Organometallic Chemistry 07/2011; 696(13):2528-2532. · 2.30 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: In the course of the “atopic march”, sensitization to food allergens appears earliest, followed by sensitization to inhalant allergens, which is a factor favoring the subsequent development of asthma. While the sequence atopic dermatitis and/or food sensitization (allergy)–asthma–allergic rhinitis is usually the case, exceptions to this schema are relatively frequent. Asthma and food allergy, conditions occurring more and more often, are closely linked, especially in children. Note that bronchospasm can be a symptom of food allergy. Note also that asthmatic disease is one of the principal risk factors for severe anaphylaxis and death associated with food allergy, with recognized under-utilization of auto-injectable adrenalin. Conversely, because of the “intrinsic” severity of asthma, food allergy represents an important risk factor for severe acute asthma, being able to put the life, especially that of young children, adolescents and young adults, in danger. In practice, one must: (I) look for a history of asthma or existing asthma in all patients suspected of having food allergy, (II) be assured of optimal control of asthma diagnosed during the course of a food allergy workup, and (III) in all cases, refer the patient to an allergy specialist, because experience proves that one food allergic patient out of two does not benefit from such a consultation and the resulting special recommendations.
    Revue Française d Allergologie 04/2011; 51(3):248-254. · 0.22 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: This randomized controlled trial compared the use of an intensive and conventional insulin protocol on clinical outcomes in patients with severe sepsis and septic shock, in the first 72 hours. It was conducted at a university hospital in the city of São Paulo. Patients (n=46) were allocated into two groups: intensive glycemic (blood glucose between 80-110mg/dl) and conventional (180-220mg/dl). The Student's t-test and chi-square test were used for data analysis. A statistically significant (p<0.001) difference was observed in mean glycemia, but there was no difference in the variables of mean minimum arterial pressure (p=0.06) or maximum (p=0.11), serum creatinine (p=0,33) or in mortality (p=0.11). Although there was no difference between the groups regarding mortality, hemodynamic instability in the conventional group was longer and the only deaths occurred in it.
    Revista da Escola de Enfermagem da U S P 06/2013; 47(3):615-20. · 0.50 Impact Factor