Intensive versus Conventional Glucose Control in Critically Ill Patients

被引：3278

作者：

Finfer, S. ^{[20
]}

Blair, D.

Bellomo, R. ^{[4
]}

McArthur, C. ^{[2
]}

Mitchell, I. ^{[8
]}

Myburgh, J. ^{[21
]}

Norton, R.

Potter, J. ^{[20
]}

Chittock, D. ^{[44
]}

Dhingra, V.

Foster, D.

Cook, D. ^{[37
]}

Dodek, P. ^{[39
]}

Hebert, P.

Henderson, W.

Heyland, D.

McDonald, E. ^{[37
]}

Ronco, J.

Schweitzer, L.

Peto, R.

Sandercock, P.

Sprung, C.

Young, J. D.

Su, S. ^{[1
]}

Heritier, S. ^{[1
]}

Li, Q. ^{[1
]}

Bompoint, S. ^{[1
]}

Billot, L. ^{[1
]}

Crampton, L. ^{[1
]}

Darcy, F. ^{[1
]}

Jayne, K. ^{[1
]}

Kumarasinghe, V. ^{[1
]}

Little, L. ^{[1
,25
]}

McEvoy, S. ^{[1
]}

MacMahon, S. ^{[1
]}

Pandey, S. ^{[1
]}

Ryan, S. ^{[1
]}

Shukla, R. ^{[1
]}

Vijayan, B. ^{[1
]}

Atherton, S. ^{[2
]}

Bell, J. ^{[2
]}

Hadfield, L. ^{[2
]}

Hourigan, C. ^{[2
]}

McArthur, C. ^{[2
]}

Newby, L. ^{[2
]}

Simmonds, C. ^{[2
]}

Buhr, H. ^{[3
]}

Eccleston, M. ^{[3
]}

McGuinness, S. ^{[3
]}

Parke, R. ^{[3
]}

机构：

[1] Univ Sydney, George Inst Int Hlth, Sydney, NSW 2006, Australia

[2] Auckland City Hosp, Dept Crit Care Med, Auckland, New Zealand

[3] Auckland City Hosp, Cardiovasc Intens Care Unit, Auckland, New Zealand

[4] Austin Hosp, Melbourne, Vic 3084, Australia

[5] Ballarat Base Hosp, Ballarat, Vic, Australia

[6] Blacktown Hosp, Blacktown, NSW, Australia

[7] Box Hill Hosp, Box Hill, Vic, Australia

[8] Canberra Hosp, Canberra, ACT, Australia

[9] Concord Repatriat Gen Hosp, Concord, NSW, Australia

[10] Fremantle Hosp, Fremantle, WA, Australia

[11] John Hunter Hosp, Newcastle, NSW, Australia

[12] Liverpool Hosp, Liverpool, NSW, Australia

[13] Middlemore Hosp, Auckland 6, New Zealand

[14] Nepean Hosp, Nepean, NSW, Australia

[15] N Shore Hosp, Auckland, New Zealand

[16] Prince Wales Hosp, Sydney, NSW, Australia

[17] Queen Elizabeth Hosp, Adelaide, SA, Australia

[18] Royal Brisbane Hosp, Brisbane, Qld 4029, Australia

[19] Royal Hobart Hosp, Hobart, Tas, Australia

[20] Royal N Shore Hosp, Sydney, NSW, Australia

[21] St George Hosp, Sydney, NSW, Australia

[22] St Vincents Hosp, Melbourne, Vic, Australia

[23] Sir Charles Gairdner Hosp, Perth, WA, Australia

[24] Wellington Hosp, Wellington, New Zealand

[25] Western Hosp, Melbourne, Vic, Australia

[26] Wollongong Hosp, Wollongong, NSW, Australia

[27] NSW Inst Trauma & Injury Management, Sydney, NSW, Australia

[28] Australian & New Zealand Intens Care Res Ctr, Melbourne, Vic, Australia

[29] Univ Sydney, Fac Med, Kolling Inst, Sydney, NSW 2006, Australia

[30] Royal N Shore Hosp, Dept Endocrinol, Sydney, NSW, Australia

[31] Calgary Hlth Reg, Calgary, AB, Canada

[32] Kingston Gen Hosp, Kingston, ON K7L 2V7, Canada

[33] Maisonneuve Rosemont Hosp, Montreal, PQ, Canada

[34] Mayo Clin, Rochester, MN USA

[35] Mt Sinai Hosp, Toronto, ON M5G 1X5, Canada

[36] Ottawa Gen Hosp, Ottawa, ON K1H 8L6, Canada

[37] St Josephs Healthcare, Hamilton, ON, Canada

[38] St Michaels Hosp, Toronto, ON M5B 1W8, Canada

[39] St Pauls Hosp, Vancouver, BC V6Z 1Y6, Canada

[40] Sunnybrook Hlth Sci Ctr, Toronto, ON M4N 3M5, Canada

[41] Toronto Gen Hosp, Toronto, ON, Canada

[42] Toronto Western Hosp, Toronto, ON M5T 2S8, Canada

[43] Univ Alberta Hosp, Edmonton, AB T6G 2B7, Canada

[44] Vancouver Gen Hosp, Vancouver, BC, Canada

[45] Vancouver Isl Hlth Author, Victoria, BC, Canada

来源：

NEW ENGLAND JOURNAL OF MEDICINE | 2009年 / 360卷 / 13期

基金：

英国医学研究理事会;

关键词：

TIGHT GLYCEMIC CONTROL; INSULIN THERAPY; MYOCARDIAL-INFARCTION; STRESS HYPERGLYCEMIA; DIABETIC-PATIENTS; BLOOD-GLUCOSE; CARE UNITS; MORTALITY; MANAGEMENT;

D O I：

10.1056/NEJMoa0810625

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background The optimal target range for blood glucose in critically ill patients remains unclear. Methods Within 24 hours after admission to an intensive care unit (ICU), adults who were expected to require treatment in the ICU on 3 or more consecutive days were randomly assigned to undergo either intensive glucose control, with a target blood glucose range of 81 to 108 mg per deciliter (4.5 to 6.0 mmol per liter), or conventional glucose control, with a target of 180 mg or less per deciliter (10.0 mmol or less per liter). We defined the primary end point as death from any cause within 90 days after randomization. Results Of the 6104 patients who underwent randomization, 3054 were assigned to undergo intensive control and 3050 to undergo conventional control; data with regard to the primary outcome at day 90 were available for 3010 and 3012 patients, respectively. The two groups had similar characteristics at baseline. A total of 829 patients (27.5%) in the intensive-control group and 751 (24.9%) in the conventional-control group died (odds ratio for intensive control, 1.14; 95% confidence interval, 1.02 to 1.28; P = 0.02). The treatment effect did not differ significantly between operative (surgical) patients and nonoperative (medical) patients (odds ratio for death in the intensive-control group, 1.31 and 1.07, respectively; P = 0.10). Severe hypoglycemia (blood glucose level, = 40 mg per deciliter [2.2 mmol per liter]) was reported in 206 of 3016 patients (6.8%) in the intensive-control group and 15 of 3014 (0.5%) in the conventional-control group (P<0.001). There was no significant difference between the two treatment groups in the median number of days in the ICU (P = 0.84) or hospital (P = 0.86) or the median number of days of mechanical ventilation (P = 0.56) or renal-replacement therapy (P = 0.39). Conclusions In this large, international, randomized trial, we found that intensive glucose control increased mortality among adults in the ICU: a blood glucose target of 180 mg or less per deciliter resulted in lower mortality than did a target of 81 to 108 mg per deciliter. (ClinicalTrials.gov number, NCT00220987.)

引用

页码：1283 / 1297

页数：15

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