Journal Article10.1056/NEJMOA070716
Intensive insulin therapy and pentastarch resuscitation in severe sepsis.
Frank M. Brunkhorst,Christoph Engel,Frank Bloos,Andreas Meier-Hellmann,Max Ragaller,Norbert Weiler,Onnen Moerer,Matthias Gruendling,Michael Oppert,Stefan Grond,Derk Olthoff,Ulrich Jaschinski,Stefan John,Rolf Rossaint,Tobias Welte,Martin Schaefer,Peter M. Kern,Evelyn Kuhnt,Michael Kiehntopf,Christiane S. Hartog,Charles Natanson,Markus Loeffler,Konrad Reinhart +22 more
TL;DR: The use of intensive insulin therapy placed critically ill patients with sepsis at increased risk for serious adverse events related to hypoglycemia and HES was harmful, and its toxicity increased with accumulating doses.
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Abstract: A b s t r ac t Background The role of intensive insulin therapy in patients with severe sepsis is uncertain. Fluid resuscitation improves survival among patients with septic shock, but evidence is lacking to support the choice of either crystalloids or colloids. Methods In a multicenter, two-by-two factorial trial, we randomly assigned patients with severe sepsis to receive either intensive insulin therapy to maintain euglycemia or conventional insulin therapy and either 10% pentastarch, a low-molecular-weight hydroxyethyl starch (HES 200/0.5), or modified Ringer’s lactate for fluid resuscitation. The rate of death at 28 days and the mean score for organ failure were coprimary end points. Results The trial was stopped early for safety reasons. Among 537 patients who could be evaluated, the mean morning blood glucose level was lower in the intensive-therapy group (112 mg per deciliter [6.2 mmol per liter]) than in the conventional-therapy group (151 mg per deciliter [8.4 mmol per liter], P<0.001). However, at 28 days, there was no significant difference between the two groups in the rate of death or the mean score for organ failure. The rate of severe hypoglycemia (glucose level, ≤40 mg per deciliter [2.2 mmol per liter]) was higher in the intensive-therapy group than in the conventional-therapy group (17.0% vs. 4.1%, P<0.001), as was the rate of serious adverse events (10.9% vs. 5.2%, P = 0.01). HES therapy was associated with higher rates of acute renal failure and renal-replacement therapy than was Ringer’s lactate. Conclusions The use of intensive insulin therapy placed critically ill patients with sepsis at increased risk for serious adverse events related to hypoglycemia. As used in this study, HES was harmful, and its toxicity increased with accumulating doses. (ClinicalTrials. gov number, NCT00135473.)
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Citations
Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012.
R. P. Dellinger,Mitchell M. Levy,Andrew Rhodes,Djillali Annane,Herwig Gerlach,Steven M. Opal,Jonathan E. Sevransky,Charles L. Sprung,Ivor S. Douglas,Roman Jaeschke,Tiffany M. Osborn,Mark E. Nunnally,Konrad Reinhart,Ruth M. Kleinpell,Derek C. Angus,Clifford S. Deutschman,Flávia Ribeiro Machado,Gordon D. Rubenfeld,Steven A R Webb,Richard Beale,Jean Louis Vincent,Rui Moreno +21 more
TL;DR: An update to the “Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock,” last published in 2008 is provided.
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TL;DR: A consensus committee of 68 international experts representing 30 international organizations was convened in 2008 to provide an update to the "Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock".
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Definitions for Sepsis and Organ Failure and Guidelines for the Use of Innovative Therapies in Sepsis
Roger C. Bone,Robert A. Balk,F. B. Cerra,R. P. Dellinger,A. M. Fein,William A. Knaus,Roland M. H. Schein,W. J. Sibbald +7 more
TL;DR: An American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference was held in Northbrook in August 1991 with the goal of agreeing on a set of definitions that could be applied to patients with sepsis and its sequelae as mentioned in this paper.
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Intensive Insulin Therapy in Critically Ill Patients
Greet Van den Berghe,Pieter Wouters,Frank Weekers,Charles Verwaest,Frans Bruyninckx,Miet Schetz,Dirk Vlasselaers,Patrick Ferdinande,Peter Lauwers,Roger Bouillon +9 more
TL;DR: Intensive insulin therapy to maintain blood glucose at or below 110 mg per deciliter reduces morbidity and mortality among critically ill patients in the surgical intensive care unit.
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Members of the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference Committee: American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis
Roger C. Bone,Robert A. Balk,F. B. Cerra,R. P. Dellinger,A. M. Fein,William A. Knaus,Roland M. H. Schein,W. J. Sibbald,WA Knous,J. H. Abrams,G. R. Bernard,JW Biondi,JE Calvin,R Demling,PJ Fahey,CJ Fisher,C Franklin,KJ Gorelick,MA Kelley,DG Maki,JC Marshall,WW Merrill,JP Pribble,EC Rackow,Timothy C. Rodell,JN Sheagren,Michael R. Silver,C. L. Sprung,Richard C. Straube,MJ Tobin,GM Trenholme,DP Wagner,CD Webb,JC Wherry,HP Wiedemann,CH Wortel,M. Kylänpää-Bäck +36 more
- 19 Feb 1992
Abstract: Objective:To define the terms “sepsis” and “organ failure” in a precise manner. Data Sources:Review of the medical literature and the use of expert testimony at a consensus conference. Setting:American College of Chest Physicians (ACCP) headquarters in Northbrook, IL. Participants:Leadership members of ACCP/ Society of Critical Care Medicine (SCCM). Results:An ACCP/SCCM Consensus Conference was held in August of 1991 with the goal of agreeing on a set of definitions that could be applied to patients with sepsis and its sequelae. New definitions were offered for some terms, while others were discarded. Broad definitions of sepsis and the systemic inflammatory response syndrome were proposed, along with detailed physiologic variables by which a patient could be categorized. Definitions for severe sepsis, septic shock, hypotension, and multiple organ dysfunction syndrome were also offered. The use of severity scoring methods were recommended when dealing with septic patients as an adjunctive tool to assess mortality. Appropriate methods and applications for the use and testing of new therapies were recommended. Conclusion:The use of these terms and techniques should assist clinicians and researchers who deal with sepsis and its sequelae.
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Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock
R. Phillip Dellinger,Jean Carlet,Henry Masur,Herwig Gerlach,Thierry Calandra,Jonathan Cohen,Juan Gea-Banacloche,Didier Keh,John C. Marshall,Margaret M. Parker,Graham Ramsay,Janice L. Zimmerman,Jean Louis Vincent,Mitchell M. Levy +13 more
TL;DR: Evidence-based recommendations can be made regarding many aspects of the acute management of sepsis and septic shock that will hopefully translate into improved outcomes for the critically ill patient.
Intensive insulin therapy in the medical ICU.
Greet Van den Berghe,Alexander Wilmer,Greet Hermans,Wouter Meersseman,Pieter Wouters,Ilse Milants,Eric Van Wijngaerden,Herman Bobbaers,Roger Bouillon +8 more
TL;DR: Intensive insulin therapy significantly reduced morbidity but not mortality among all patients in the medical ICU, and the risk of subsequent death and disease was reduced in patients treated for three or more days.
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