Intensive insulin therapy in postoperative intensive care unit patients

A decision analysis

Moritoki Egi, Rinaldo Bellomo, Edward Stachowski, Craig J. French, Graeme Hart, Peter Stow, Weiqui Li, Samantha Bates

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Rationale: Intensive insulin therapy (IIT) may reduce mortality in mechanically ventilated postoperative patients. Objectives: To assess the risks and benefits of IIT in different institutions. Design: Retrospective, blinded-to-outcome selection of patient cohorts from four hospitals. Methods: Selection of a cohort of patients with clinical features similar to those reported in a recent study of IIT and of all mechanically ventilated postoperative patients from each hospital. Retrieval of information on glucose control. Assessment of risks and benefits and final outcomes. Measurements and Main Results: We selected 783 consecutive patients with similar clinical and demographic features to the IIT trial control group and four general cohorts for a total of 4,150 consecutive mechanically ventilated postoperative patients. In these patients, glucose levels were measured 212,663 times for amean value of 8.22 ± 2.7 mmol/L (148 ± 49 mg/dl). Intensive care unit (ICU) mortality varied from 2.2 to 13.6%. The incidence of hypoglycemia (defined as < 2.2 mmol/L) varied from 1.4 to 2.7%. Assuming a beneficial effect of IIT as reported, the number needed to treat to save one life varied from 38 in one ICU to 125 in another, whereas the rate of hypoglycemia (number needed to harm) varied from 7 to 13. Conclusions: The number needed to treat to prevent an ICU death and the associated risk of hypoglycemia (number needed to harm) with IIT vary widely according to baseline mortality, case mix, and case selection. Rational decision analysis in individual ICUs should take these factors into account.

Original languageEnglish
Pages (from-to)407-413
Number of pages7
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume173
Issue number4
DOIs
Publication statusPublished - 15 Feb 2006
Externally publishedYes

Keywords

  • Critical care
  • Critical illness
  • Glucose
  • Insulin
  • Mortality, number needed to treat

Cite this

Egi, Moritoki ; Bellomo, Rinaldo ; Stachowski, Edward ; French, Craig J. ; Hart, Graeme ; Stow, Peter ; Li, Weiqui ; Bates, Samantha. / Intensive insulin therapy in postoperative intensive care unit patients : A decision analysis. In: American Journal of Respiratory and Critical Care Medicine. 2006 ; Vol. 173, No. 4. pp. 407-413.
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abstract = "Rationale: Intensive insulin therapy (IIT) may reduce mortality in mechanically ventilated postoperative patients. Objectives: To assess the risks and benefits of IIT in different institutions. Design: Retrospective, blinded-to-outcome selection of patient cohorts from four hospitals. Methods: Selection of a cohort of patients with clinical features similar to those reported in a recent study of IIT and of all mechanically ventilated postoperative patients from each hospital. Retrieval of information on glucose control. Assessment of risks and benefits and final outcomes. Measurements and Main Results: We selected 783 consecutive patients with similar clinical and demographic features to the IIT trial control group and four general cohorts for a total of 4,150 consecutive mechanically ventilated postoperative patients. In these patients, glucose levels were measured 212,663 times for amean value of 8.22 ± 2.7 mmol/L (148 ± 49 mg/dl). Intensive care unit (ICU) mortality varied from 2.2 to 13.6{\%}. The incidence of hypoglycemia (defined as < 2.2 mmol/L) varied from 1.4 to 2.7{\%}. Assuming a beneficial effect of IIT as reported, the number needed to treat to save one life varied from 38 in one ICU to 125 in another, whereas the rate of hypoglycemia (number needed to harm) varied from 7 to 13. Conclusions: The number needed to treat to prevent an ICU death and the associated risk of hypoglycemia (number needed to harm) with IIT vary widely according to baseline mortality, case mix, and case selection. Rational decision analysis in individual ICUs should take these factors into account.",
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Intensive insulin therapy in postoperative intensive care unit patients : A decision analysis. / Egi, Moritoki; Bellomo, Rinaldo; Stachowski, Edward; French, Craig J.; Hart, Graeme; Stow, Peter; Li, Weiqui; Bates, Samantha.

In: American Journal of Respiratory and Critical Care Medicine, Vol. 173, No. 4, 15.02.2006, p. 407-413.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Intensive insulin therapy in postoperative intensive care unit patients

T2 - A decision analysis

AU - Egi, Moritoki

AU - Bellomo, Rinaldo

AU - Stachowski, Edward

AU - French, Craig J.

AU - Hart, Graeme

AU - Stow, Peter

AU - Li, Weiqui

AU - Bates, Samantha

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N2 - Rationale: Intensive insulin therapy (IIT) may reduce mortality in mechanically ventilated postoperative patients. Objectives: To assess the risks and benefits of IIT in different institutions. Design: Retrospective, blinded-to-outcome selection of patient cohorts from four hospitals. Methods: Selection of a cohort of patients with clinical features similar to those reported in a recent study of IIT and of all mechanically ventilated postoperative patients from each hospital. Retrieval of information on glucose control. Assessment of risks and benefits and final outcomes. Measurements and Main Results: We selected 783 consecutive patients with similar clinical and demographic features to the IIT trial control group and four general cohorts for a total of 4,150 consecutive mechanically ventilated postoperative patients. In these patients, glucose levels were measured 212,663 times for amean value of 8.22 ± 2.7 mmol/L (148 ± 49 mg/dl). Intensive care unit (ICU) mortality varied from 2.2 to 13.6%. The incidence of hypoglycemia (defined as < 2.2 mmol/L) varied from 1.4 to 2.7%. Assuming a beneficial effect of IIT as reported, the number needed to treat to save one life varied from 38 in one ICU to 125 in another, whereas the rate of hypoglycemia (number needed to harm) varied from 7 to 13. Conclusions: The number needed to treat to prevent an ICU death and the associated risk of hypoglycemia (number needed to harm) with IIT vary widely according to baseline mortality, case mix, and case selection. Rational decision analysis in individual ICUs should take these factors into account.

AB - Rationale: Intensive insulin therapy (IIT) may reduce mortality in mechanically ventilated postoperative patients. Objectives: To assess the risks and benefits of IIT in different institutions. Design: Retrospective, blinded-to-outcome selection of patient cohorts from four hospitals. Methods: Selection of a cohort of patients with clinical features similar to those reported in a recent study of IIT and of all mechanically ventilated postoperative patients from each hospital. Retrieval of information on glucose control. Assessment of risks and benefits and final outcomes. Measurements and Main Results: We selected 783 consecutive patients with similar clinical and demographic features to the IIT trial control group and four general cohorts for a total of 4,150 consecutive mechanically ventilated postoperative patients. In these patients, glucose levels were measured 212,663 times for amean value of 8.22 ± 2.7 mmol/L (148 ± 49 mg/dl). Intensive care unit (ICU) mortality varied from 2.2 to 13.6%. The incidence of hypoglycemia (defined as < 2.2 mmol/L) varied from 1.4 to 2.7%. Assuming a beneficial effect of IIT as reported, the number needed to treat to save one life varied from 38 in one ICU to 125 in another, whereas the rate of hypoglycemia (number needed to harm) varied from 7 to 13. Conclusions: The number needed to treat to prevent an ICU death and the associated risk of hypoglycemia (number needed to harm) with IIT vary widely according to baseline mortality, case mix, and case selection. Rational decision analysis in individual ICUs should take these factors into account.

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KW - Critical illness

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