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