Intensive insulin therapy and pentastarch resuscitation in severe sepsis.
@article{Brunkhorst2008IntensiveIT, title={Intensive insulin therapy and pentastarch resuscitation in severe sepsis.}, author={Frank Brunkhorst and Christoph Engel and Frank Bloos and Andreas Meier‑Hellmann and Maximilian Ragaller and Norbert Weiler and Onnen Moerer and Matthias Gruendling and Michael Oppert and Stefan Grond and Derk Olthoff and Ulrich Jaschinski and Stefan John and Rolf Rossaint and Tobias Welte and Martin Schaefer and P Kern and Evelyn Kuhnt and Michael Kiehntopf and Christiane S. Hartog and Charles Natanson and Markus W. Loeffler and Konrad Reinhart}, journal={The New England journal of medicine}, year={2008}, volume={358 2}, pages={ 125-39 } }
BACKGROUND
The role of intensive insulin therapy in patients with severe sepsis is uncertain. Fluid resuscitation improves survival among patients with septic shock, but evidence is lacking to support the choice of either crystalloids or colloids.
METHODS
In a multicenter, two-by-two factorial trial, we randomly assigned patients with severe sepsis to receive either intensive insulin therapy to maintain euglycemia or conventional insulin therapy and either 10% pentastarch, a low-molecular…
2,630 Citations
The use of intensive insulin therapy and pentastarch resuscitation in patients with severe sepsis
- Medicine
- 2009
The use of the intensive insulin therapy placed critically ill patients with sepsis at an increased risk for serious adverse events related to hypoglycemia and HES was harmful and its toxicity increased with accumulating doses.
Clinical controversies in the management of critically ill patients with severe sepsis
- MedicineVirulence
- 2014
Current data support the use of a crystalloid fluid with the addition of albumin when needed for fluid resuscitation and stress hyperglycemia should be treated when blood glucose concentration exceeds 180 mg/dL.
Hydroxyethyl starch for fluid resuscitation in critically ill patients
- MedicineCanadian Journal of Anesthesia/Journal canadien d'anesthésie
- 2013
The primary efficacy outcome was death within 90 days after randomization and the key secondary outcomes were incidence of acute kidney injury and development of new organ dysfunction, defined by the sequential organ failure assessment score.
Hydroxyethyl starch or saline for fluid resuscitation in intensive care.
- MedicineThe New England journal of medicine
- 2012
In patients in the ICU, there was no significant difference in 90-day mortality between patients resuscitated with 6% HES (130/0.4) or saline, however, more patients who received resuscitation with HES were treated with renal-replacement therapy.
Corticosteroid treatment and intensive insulin therapy for septic shock in adults: a randomized controlled trial.
- Medicine, BiologyJAMA
- 2010
Compared with conventional insulin therapy, intensive insulin therapy did not improve in-hospital mortality among patients who were treated with hydrocortisone for septic shock and the addition of oral fludrocort isone did not result in a statistically significant improvement in in- hospital mortality.
Intensive insulin therapy reduces infections in patients on parenteral nutrition- A randomized clinical trial
- Medicine
- 2012
IIT reduced pathogen growth without hypoglycemic episodes in head trauma patients, and this effect was improved in tight control group but not significant between two groups due to low sample size.
Hydroxyethyl starch 130/0.42 versus Ringer's acetate in severe sepsis.
- MedicineThe New England journal of medicine
- 2012
Patients with severe sepsis assigned to fluid resuscitation with HES 130/0.42 had an increased risk of death at day 90 and were more likely to require renal-replacement therapy, as compared with those receiving Ringer's acetate.
INTENSIVE INSULIN THERAPY FOR STRESS HYPERGLYCEMIA
- Medicine
- 2008
The evidence supporting tight glycemic control and the tools available to accomplish it are reviewed and it is increasingly clear that patients who have severe sepsis are at increased risk for hypoglycemia during IIT.
Intensive insulin treatment improves forearm blood flow in critically ill patients: a randomized parallel design clinical trial
- MedicineCritical care
- 2009
Compared to standard treatment, intensive insulin treatment of critically ill patients increases forearm flow, and flow increase was weakly related to the insulin dose, though not to blood glucose concentration.
A carbohydrate-restrictive strategy is safer and as efficient as intensive insulin therapy in critically ill patients.
- MedicineJournal of critical care
- 2010
References
SHOWING 1-10 OF 48 REFERENCES
Intensive insulin therapy in septic shock.
- MedicineCritical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine
- 2006
The current evidence suggests IIT should be implemented, aiming for the lowest glycaemic range that can be safely achieved while avoiding hypoglycaemia, and a review of the risks of hypglycaemia.
Intensive insulin therapy in critically ill patients.
- MedicineThe New England journal of medicine
- 2001
Intensive insulin therapy to maintain blood glucose at or below 110 mg per deciliter reduces morbidity and mortality among critically ill patients in the surgical intensive care unit.
Outcome benefit of intensive insulin therapy in the critically ill: Insulin dose versus glycemic control*
- MedicineCritical care medicine
- 2003
Normoglycemia was safely reached within 24 hrs and maintained during intensive care by using insulin titration guidelines, and metabolic control, as reflected by normoglycesmia, rather than the infused insulin dose per se, was related to the beneficial effects of intensive insulin therapy.
Effects of hydroxyethylstarch and gelatin on renal function in severe sepsis: a multicentre randomised study
- MedicineThe Lancet
- 2001
Compared with crystalloid, colloid therapy slows progression of extrapulmonary tissue injury in septic sheep.
- MedicineJournal of applied physiology
- 1994
It is concluded that chronic intravascular volume resuscitation of hyperdynamic sepsis with pentastarch ameliorated the progression of both microvascular and parenchymal injury.
Effects of hydroxyethyl starch administration on renal function in critically ill patients.
- Medicine, BiologyBritish journal of anaesthesia
- 2007
Hematological cancer, the presence of sepsis, cardiovascular failure, and baseline renal function as assessed by the SOFA score were independent risk factors for the subsequent need for RRT in the ICU.
Intensive insulin therapy in critically ill patients.
- MedicineThe New England journal of medicine
- 2002
This commentary reviews the problems of glucose measurements arising from matrix effects, interferences and the use of different assays and concludes that point-of-care testing is the best way of monitoring blood glucose.
Intensive Insulin Therapy in Critical Care
- MedicineDiabetes Care
- 2007
The lack of consensus in the delivery of intravenous insulin infusions is reflected in the wide variability of practice noted in this survey and mandates close attention to the choice of a protocol.
Effect of hydroxyethylstarch on renal function in cardiac surgery: a large scale retrospective study.
- MedicineActa anaesthesiologica Belgica
- 2005
The use of HES 200 kD, 0.5 DS in cardiac surgery does not seem to be associated with a clinically significant deterioration of postoperative renal function.
Colloids versus crystalloids for fluid resuscitation in critically ill patients.
- MedicineThe Cochrane database of systematic reviews
- 2000
There is no evidence from randomised controlled trials that resuscitation with colloids reduces the risk of death compared to crystalloids in patients with trauma, burns and following surgery.