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Intensive insulin versus conventional treatment for hyperglycaemia in critically ill patients

Report by: Craig Ferguson, SPR in Emergency Medicine

Search checked by: Lisa MacKenzie, SpR Emergency Medicine

Institution: Salford Royal Foundation Trust, Manchester, UK

Three-part question

In (critically ill patients) does the use of (intensive glucose control) improve (survival)?

Clinical scenario

You start at a new hospital and find that there is a protocol in place to guide the treatment of patients with sepsis. It states that if the patient's blood glucose is found to be greater than 7.8 mmol/l then insulin should to be started to keep it tightly controlled. You wonder if some degree of hyperglycaemia is not such a bad thing, given that it is part of a natural physiological response to stress and glucose is required for brain metabolism. A quick review of the literature throws up contrasting results and so you decide that you should really examine the evidence in a more systematic manner.

Search strategy

Medline through OVID interface February 2010. EMBASE through OVID interface March 2010. Cochrane Library DARE Google Scholar. The following search was applied to Medline and EMBASE: ((tight adj5 glucose).mp. OR (intensive adj5 glucose).mp. OR(tight adj5 insulin).mp. OR (intensive adj5 insulin).mp. OR (strict adj5 glucose).mp. OR (strict adj5 insulin).mp. OR (hyperglyc$ adj5 stroke).mp. OR (critical adj5 glucose).mp. OR (critical adj5 insulin).mp. OR (critical adj5 glyc?emic).mp. OR (intensive adj5 glyc?emic).mp. OR (tight adj5 glyc?emic).mp. OR (strict adj5 glyc?emic).mp.) AND (exp Critical Care/OR exp Intensive Care Units/ OR exp Intensive Care/OR itu.mp. OR icu.mp. OR critical$ ill$.mp. OR sepsis.mp. OR exp Sepsis/OR exp Shock, Traumatic/OR exp Burns/OR severe trauma$.mp. OR exp Multiple Trauma/OR exp Shock, Hemorrhagic/OR stroke.mp. OR exp Stroke/OR myocardial infarct$.mp. OR exp Myocardial Infarction/OR cva.mp. OR cerebrovascular accident.mp.) LIMIT to …

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