Pierre Kalfon1,2, Bruno Giraudeau3, Carole Ichai4, Alexandre Guerrini5,6, Nicolas Brechot7, Raphaël Cinotti8, Pierre-François Dequin9, Béatrice Riu-Poulenc10, Philippe Montravers11, Djilalli Annane12, Hervé Dupont13, Michel Sorine6, Bruno Riou14,15. 1. Service de Réanimation polyvalente, Hôpital Louis Pasteur, Hôpitaux de Chartres, Chartres Cedex, 28018, Le Coudray, France. pkalfon@ch-chartres.fr. 2. UMR INSERM 956, Université Pierre et Marie Curie, Paris, France. pkalfon@ch-chartres.fr. 3. INSERM CIC (Centre d'investigation clinique) 202, Centre Hospitalier Universitaire (CHU) de Tours, Tours, France. 4. Service de Réanimation médico-chirurgicale, Hôpital Saint-Roch, CHU de Nice, Nice, France. 5. LK2, Saint-Avertin, France. 6. Institut National de Recherche en Informatique et en Automatique (INRIA), Rocquencourt, France. 7. Service de Réanimation médicale, Institut de Cardiologie, CHU Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France. 8. Service de Réanimation chirurgicale cardio-thoracique et vasculaire, Hôpital Laennec, CHU de Nantes, Nantes, France. 9. Service de Réanimation médicale, Hôpital Bretonneau, CHRU de Tours, Tours, France. 10. Service de Réanimation polyvalente, Hôpital Purpan, CHU de Toulouse, Toulouse, France. 11. Département d'Anesthésie et Réanimation chirurgicale, CHU Bichat-Claude Bernard, AP-HP, Paris, France. 12. Service de Réanimation, CHU Raymond Poincaré, AP-HP, Garches, France. 13. Service d'Anesthésie Réanimation, Hôpital Nord, CHRU Amiens, Amiens, France. 14. UMR INSERM 956, Université Pierre et Marie Curie, Paris, France. 15. Service d'accueil des Urgences, CHU Pitié-Salpêtrière, AP-HP, Paris, France.
Abstract
PURPOSE: The blood glucose target range and optimal method to reach this range remain a matter of debate in the intensive care unit (ICU). A computer decision support system (CDSS) might improve the outcome of ICU patients through facilitation of a tighter blood glucose control. METHODS: We conducted a multi-center randomized trial in 34 French ICU. Adult patients expected to require treatment in the ICU for at least 3 days were randomly assigned without blinding to undergo tight computerized glucose control with the CDSS (TGC) or conventional glucose control (CGC), with blood glucose targets of 4.4-6.1 and <10.0 mmol/L, respectively. The primary outcome was all-cause death within 90 days after ICU admission. RESULTS: Of the 2,684 patients who underwent randomization to the TGC and CGC treatment groups, primary outcome was available for 1,335 and 1,311 patients, respectively. The baseline characteristics of these treatment groups were similar in terms of age (61 ± 16 years), SAPS II (51 ± 19), percentage of surgical admissions (40.0%) and proportion of diabetic patients (20.3%). A total of 431 (32.3%) patients in the TGC group and 447 (34.1%) in the CGC group had died by day 90 (odds ratio for death in the TGC 0.92; 95% confidence interval 0.78-1.78; p = 0.32). Severe hypoglycemia (<2.2 mmol/L) occurred in 174 of 1,317 patients (13.2%) in the TGC group and 79 of 1,284 patients (6.2%) in the CGC group (p < 0.001). CONCLUSIONS: Tight computerized glucose control with the CDSS did not significantly change 90-day mortality and was associated with more frequent severe hypoglycemia episodes in comparison with conventional glucose control.
PURPOSE: The blood glucose target range and optimal method to reach this range remain a matter of debate in the intensive care unit (ICU). A computer decision support system (CDSS) might improve the outcome of ICU patients through facilitation of a tighter blood glucose control. METHODS: We conducted a multi-center randomized trial in 34 French ICU. Adult patients expected to require treatment in the ICU for at least 3 days were randomly assigned without blinding to undergo tight computerized glucose control with the CDSS (TGC) or conventional glucose control (CGC), with blood glucose targets of 4.4-6.1 and <10.0 mmol/L, respectively. The primary outcome was all-cause death within 90 days after ICU admission. RESULTS: Of the 2,684 patients who underwent randomization to the TGC and CGC treatment groups, primary outcome was available for 1,335 and 1,311 patients, respectively. The baseline characteristics of these treatment groups were similar in terms of age (61 ± 16 years), SAPS II (51 ± 19), percentage of surgical admissions (40.0%) and proportion of diabetic patients (20.3%). A total of 431 (32.3%) patients in the TGC group and 447 (34.1%) in the CGC group had died by day 90 (odds ratio for death in the TGC 0.92; 95% confidence interval 0.78-1.78; p = 0.32). Severe hypoglycemia (<2.2 mmol/L) occurred in 174 of 1,317 patients (13.2%) in the TGC group and 79 of 1,284 patients (6.2%) in the CGC group (p < 0.001). CONCLUSIONS: Tight computerized glucose control with the CDSS did not significantly change 90-day mortality and was associated with more frequent severe hypoglycemia episodes in comparison with conventional glucose control.
Authors: G van den Berghe; P Wouters; F Weekers; C Verwaest; F Bruyninckx; M Schetz; D Vlasselaers; P Ferdinande; P Lauwers; R Bouillon Journal: N Engl J Med Date: 2001-11-08 Impact factor: 91.245
Authors: Greet Van den Berghe; Alexander Wilmer; Greet Hermans; Wouter Meersseman; Pieter J Wouters; Ilse Milants; Eric Van Wijngaerden; Herman Bobbaers; Roger Bouillon Journal: N Engl J Med Date: 2006-02-02 Impact factor: 91.245
Authors: Donald E G Griesdale; Russell J de Souza; Rob M van Dam; Daren K Heyland; Deborah J Cook; Atul Malhotra; Rupinder Dhaliwal; William R Henderson; Dean R Chittock; Simon Finfer; Daniel Talmor Journal: CMAJ Date: 2009-03-24 Impact factor: 8.262
Authors: Yaseen M Arabi; Ousama C Dabbagh; Hani M Tamim; Abdullah A Al-Shimemeri; Ziad A Memish; Samir H Haddad; Sofia J Syed; Hema R Giridhar; Asgar H Rishu; Mouhamad O Al-Daker; Salim H Kahoul; Riette J Britts; Maram H Sakkijha Journal: Crit Care Med Date: 2008-12 Impact factor: 7.598
Authors: R Phillip Dellinger; Mitchell M Levy; Jean M Carlet; Julian Bion; Margaret M Parker; Roman Jaeschke; Konrad Reinhart; Derek C Angus; Christian Brun-Buisson; Richard Beale; Thierry Calandra; Jean-Francois Dhainaut; Herwig Gerlach; Maurene Harvey; John J Marini; John Marshall; Marco Ranieri; Graham Ramsay; Jonathan Sevransky; B Taylor Thompson; Sean Townsend; Jeffrey S Vender; Janice L Zimmerman; Jean-Louis Vincent Journal: Intensive Care Med Date: 2007-12-04 Impact factor: 17.440
Authors: Andrew Rhodes; Laura E Evans; Waleed Alhazzani; Mitchell M Levy; Massimo Antonelli; Ricard Ferrer; Anand Kumar; Jonathan E Sevransky; Charles L Sprung; Mark E Nunnally; Bram Rochwerg; Gordon D Rubenfeld; Derek C Angus; Djillali Annane; Richard J Beale; Geoffrey J Bellinghan; Gordon R Bernard; Jean-Daniel Chiche; Craig Coopersmith; Daniel P De Backer; Craig J French; Seitaro Fujishima; Herwig Gerlach; Jorge Luis Hidalgo; Steven M Hollenberg; Alan E Jones; Dilip R Karnad; Ruth M Kleinpell; Younsuk Koh; Thiago Costa Lisboa; Flavia R Machado; John J Marini; John C Marshall; John E Mazuski; Lauralyn A McIntyre; Anthony S McLean; Sangeeta Mehta; Rui P Moreno; John Myburgh; Paolo Navalesi; Osamu Nishida; Tiffany M Osborn; Anders Perner; Colleen M Plunkett; Marco Ranieri; Christa A Schorr; Maureen A Seckel; Christopher W Seymour; Lisa Shieh; Khalid A Shukri; Steven Q Simpson; Mervyn Singer; B Taylor Thompson; Sean R Townsend; Thomas Van der Poll; Jean-Louis Vincent; W Joost Wiersinga; Janice L Zimmerman; R Phillip Dellinger Journal: Intensive Care Med Date: 2017-01-18 Impact factor: 17.440
Authors: Jean-Charles Preiser; J Geoffrey Chase; Roman Hovorka; Jeffrey I Joseph; James S Krinsley; Christophe De Block; Thomas Desaive; Luc Foubert; Pierre Kalfon; Ulrike Pielmeier; Tom Van Herpe; Jan Wernerman Journal: J Diabetes Sci Technol Date: 2016-11-01