Intensive Versus Intermediate Glucose Control in Surgical Intensive Care Unit Patients

Author:

Okabayashi Takehiro12,Shima Yasuo2,Sumiyoshi Tatsuaki2,Kozuki Akihito2,Tokumaru Teppei2,Iiyama Tasuo3,Sugimoto Takeki1,Kobayashi Michiya1,Yokoyama Masataka4,Hanazaki Kazuhiro1

Affiliation:

1. Center for Innovative and Translational Medicine, Regenerative Medicine Group, Department of Surgery, Kochi Medical School, Kochi University, Kochi, Japan

2. Center for Innovative and Translational Medicine, Regenerative Medicine Group, Department of Surgery, Kochi Health Sciences Center, Kochi Medical School, Kochi University, Kochi, Japan

3. Center for Innovative and Translational Medicine, Regenerative Medicine Group, Department of Biostatistics, Kochi Medical School, Kochi University, Kochi, Japan

4. Center for Innovative and Translational Medicine, Regenerative Medicine Group, Department of Anesthesiology and Intensive Care Medicine, Kochi Medical School, Kochi University, Kochi, Japan

Abstract

OBJECTIVE The optimal perioperative blood glucose range to improve surgical site infection (SSI) in surgical intensive care unit (ICU) patients remains unclear. We sought to determine whether the incidence of SSI is reduced by perioperative intensive insulin therapy (IT). RESEARCH DESIGN AND METHODS Patients were randomly assigned to receive perioperative intensive IT, with a target blood glucose range of 4.4–6.1 mmol/L, or intermediate IT, with a target blood glucose range of 7.7–10.0 mmol/L in the surgical ICU. We defined the primary end point as the incidence of SSI. RESULTS Study participants were randomly assigned to glucose control with one of two target ranges: for 225 patients in the intermediate IT group or for 222 patients in the intensive IT group, respectively. No patients in either group became hypoglycemic (<4.4 mmol/L) during their stay in the surgical ICU. In our series, the rate of SSI after hepato-biliary-pancreatic surgery was 6.7%. Patients in the intensive IT group, compared with the intermediate IT group, had fewer postoperative SSIs (9.8% vs. 4.1%, P = 0.028) and a lower incidence of postoperative pancreatic fistula after pancreatic resection (P = 0.040). The length of hospitalization required for patients in the intensive IT group was significantly shorter than that in the intermediate IT group (P = 0.017). CONCLUSIONS We found that intensive IT decreased the incidence of SSI among patients who underwent hepato-biliary-pancreatic surgery: a blood glucose target of 4.4 to 6.1 mmol/L resulted in lower rate of SSI than did a target of 7.7–10.0 mmol/L.

Publisher

American Diabetes Association

Subject

Advanced and Specialized Nursing,Endocrinology, Diabetes and Metabolism,Internal Medicine

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