Critically Ill Patients
Conditions
Keywords
critical care, glycemic control, insulin, nitrogen balance
Brief summary
To compare the differences of urinary nitrogen excretion, nitrogen balance and clinical outcomes between tightly insulin therapy and conventional insulin therapy in the ICU.
Detailed description
Critical illness is associated with increased circulating concentrations of proinflammatory cytokines, such as tumor necrosis factor (TNF-α), interleukin (IL)-1, and IL-6 which may be important mediators of insulin resistance and results in hyperglycemia. Altered glucose metabolism was caused by release of counter regulatory hormones such as glucagons; epinephrine and cortisol oppose the normal action of insulin, leading to an increase in skeletal muscle proteolysis. It did not know whether tightly glucose control had beneficial effect in urinary nitrogen excretion and nitrogen balance.
Interventions
OTHERTightly glucose control
A continuous insulin infusion (50 IU of Actrapid HM) in 49.5 ml of 0.9 percent sodium chloride with the use of a pump was started when blood glucose level exceeded 140 mg/dl to maintain a blood glucose level of between 120 and 140 mg per deciliter. The dose of insulin was adjusted according to whole-blood glucose levels, measured at one-four-hour interval in arterial blood or arterial catheter was not available. The insulin dose was adjusted by a neuro-fuzzy method
OTHERConventional glucose control
a continuous insulin infusion was delivered when the blood glucose level exceeded 200 mg/dl and insulin level was then adjusted to maintain a blood glucose level of between 180 and 200 mg per deciliter.
Sponsors
Kaohsiung Veterans General Hospital.
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients admitted to the adult ICU who had baseline blood glucose \> 180 mg/dl * expected to require treatment in the ICU on 3 or more consecutive days.
Exclusion criteria
* pregnant patients * patients with chronic renal loss (Chronic renal loss was defined as persistent acute renal failure, complete loss of kidney function \> 4 weeks)
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| 24-hour urinary urea nitrogen(UUN)excretion, nitrogen balance and serum albumin and prealbumin. | up to the 14th study day |
Secondary
| Measure | Time frame |
|---|---|
| ICU day, ventilator day, hospital day, episodes of acute renal injury, bacteremia, blood transfusion, gastrointestinal (GI) bleeding, hypoglycemia, and hospital mortality rate. | up to ICU discharge |
Countries
Taiwan
Outcome results
None listed