OBJECTIVE: To document current management of blood glucose in Australian and New Zealand intensive care units (ICUs) and to investigate the association between insulin administration, blood glucose concentration and hospital outcome. DESIGN AND SETTING: Practice survey and inception cohort study in closed multi-disciplinary ICUs in Australia and New Zealand. PATIENTS: Twenty-nine ICU directors and 939 consecutive admissions to 29 ICUs during a 2-week period. MEASUREMENT AND RESULTS: Data collected included unit approaches to blood glucose management, patient characteristics, blood glucose concentrations, insulin administration and patient outcomes. Ten percent of the ICU directors reported using an intensive insulin regimen in all their patients. In 861 patients (91.7%) blood glucose concentration was greater than 6.1[Symbol: see text]mmol/l, 287 (31.1%) received insulin, and the median blood glucose concentration triggering insulin administration was 11.5 (IQR 9.4-14) mmol/l. Univariate analysis demonstrated that non-survivors had a higher maximum daily blood glucose concentration (12 mmol/l, 9.4-14.8, vs. 9.5, 7.6-12.2) and were more likely to receive insulin (47% vs. 28%). Multiple logistic regression analysis showed age (OR per 5-year decrease 0.93, 95% CI 0.87-1.00) and APACHE II (OR per point decrease 0.87, 95% CI 0.84-0.90) to be independently associated with hospital mortality. After controlling for age and APACHE II both daily highest blood glucose (OR 0.95, 95% CI 0.90-1.00) and administration of insulin (OR 0.62, 95% CI 0.39-1.00) were independently associated when added to the model alone; neither was independently associated when they were simultaneously included in the model. CONCLUSION: Few Australian and New Zealand ICUs have adopted intensive insulin therapy. In this study, insulin administration and highest daily blood glucose concentration could not be separated in their association with hospital mortality.
OBJECTIVE: To document current management of blood glucose in Australian and New Zealand intensive care units (ICUs) and to investigate the association between insulin administration, blood glucose concentration and hospital outcome. DESIGN AND SETTING: Practice survey and inception cohort study in closed multi-disciplinary ICUs in Australia and New Zealand. PATIENTS: Twenty-nine ICU directors and 939 consecutive admissions to 29 ICUs during a 2-week period. MEASUREMENT AND RESULTS: Data collected included unit approaches to blood glucose management, patient characteristics, blood glucose concentrations, insulin administration and patient outcomes. Ten percent of the ICU directors reported using an intensive insulin regimen in all their patients. In 861 patients (91.7%) blood glucose concentration was greater than 6.1[Symbol: see text]mmol/l, 287 (31.1%) received insulin, and the median blood glucose concentration triggering insulin administration was 11.5 (IQR 9.4-14) mmol/l. Univariate analysis demonstrated that non-survivors had a higher maximum daily blood glucose concentration (12 mmol/l, 9.4-14.8, vs. 9.5, 7.6-12.2) and were more likely to receive insulin (47% vs. 28%). Multiple logistic regression analysis showed age (OR per 5-year decrease 0.93, 95% CI 0.87-1.00) and APACHE II (OR per point decrease 0.87, 95% CI 0.84-0.90) to be independently associated with hospital mortality. After controlling for age and APACHE II both daily highest blood glucose (OR 0.95, 95% CI 0.90-1.00) and administration of insulin (OR 0.62, 95% CI 0.39-1.00) were independently associated when added to the model alone; neither was independently associated when they were simultaneously included in the model. CONCLUSION: Few Australian and New Zealand ICUs have adopted intensive insulin therapy. In this study, insulin administration and highest daily blood glucose concentration could not be separated in their association with hospital mortality.
Authors: J L Vincent; D J Bihari; P M Suter; H A Bruining; J White; M H Nicolas-Chanoin; M Wolff; R C Spencer; M Hemmer Journal: JAMA Date: 1995 Aug 23-30 Impact factor: 56.272
Authors: Peter Andrews; Elie Azoulay; Massimo Antonelli; Laurent Brochard; Christian Brun-Buisson; Daniel De Backer; Geoffrey Dobb; Jean-Yves Fagon; Herwig Gerlach; Johan Groeneveld; Duncan Macrae; Jordi Mancebo; Philipp Metnitz; Stefano Nava; Jerôme Pugin; Michael Pinsky; Peter Radermacher; Christian Richard Journal: Intensive Care Med Date: 2006-12-19 Impact factor: 17.440
Authors: Christoph Pachler; Johannes Plank; Heinz Weinhandl; Ludovic J Chassin; Malgorzata E Wilinska; Roman Kulnik; Peter Kaufmann; Karl-Heinz Smolle; Ernst Pilger; Thomas R Pieber; Martin Ellmerer; Roman Hovorka Journal: Intensive Care Med Date: 2008-02-23 Impact factor: 17.440
Authors: Sarah E Siegelaar; Maartje Hickmann; Joost B L Hoekstra; Frits Holleman; J Hans DeVries Journal: Crit Care Date: 2011-09-13 Impact factor: 9.097
Authors: Marcus J Schultz; Annick A N M Royakkers; Marcel Levi; Hazra S Moeniralam; Peter E Spronk Journal: PLoS Med Date: 2006-12 Impact factor: 11.069
Authors: Sean M Bagshaw; Rinaldo Bellomo; Michael J Jacka; Moritoki Egi; Graeme K Hart; Carol George Journal: Crit Care Date: 2009-06-17 Impact factor: 9.097