Critical Illness

CI: Blood Glucose Control (2006)

• Monitoring and Evaluation
  What impact does blood glucose control have on mortality in critically ill patients?

  • Conclusion

    Survival is decreased in critically ill patients with hyperglycemia.

  • Grade: I
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Search Plan and Results: CI: Blood Glucose 2006
     
  What impact does blood glucose control have on infectious complications in critically ill patients?

  • Conclusion

    Controlling BG is associated with fewer infectious complications in critically ill patients.

  • Grade: I
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: Blood Glucose Control: Infectious Complications
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Furnary AP, Zerr KJ, Grunkemeier GL, Starr A. Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures, Ann Thorac Surg 1999;67:352-62.
      • Golden SH, Peart-Vigilance C, Kao WH, Brancati FL. Perioperative glycemic control and the risk of infectious complications in a cohort of adults with diabetes. Diabetes Care. 1999;22(9):1408-1414.
      • Grey NJ, Perdrizet GA. Reduction of nosocomial infections in the surgical intensive-care unit by strict glycemic control. Endocr Pract. 2004 Mar-Apr;10 Suppl 2:46-52.
      • Krinsley JS Effect of an intensive glucose management protocol on the mortality of critically ill patients. Mayo Clin Proc Nov 15, 2004. 2004;79(8):992-1000.
      • Van Den Berghe G, Wouter P. Bouillon R, et al. Outcome benefit of intensive insulin therapy in the critically ill: Insulin dose versus glycemic control. Crit Care Med. 2003;31(2):359-366.  
      • Van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P and Bouillon R. Intensive Insulin Therapy in Critically Ill Patients. NEJM. 2001;345(19):1359-1367.
      • Van den Berghe G, Wilmer A, Hermans G, Meersseman W, Wouters PJ, Milants I, Wijngaerden EV, Bobbaers H, Bouillon R. Intensive insulin therapy in the medical icu. N Engl J Med 2006; 354:449-61.  
      • Zerr KJ, Furnary AP, Grunkemeier GL, Bookin S, Kanhere V, Starr A. Glucose control lowers the risk of wound infection in diabetics after open heart operations. Ann Thorac Surg 1997;63:356-61.
  • Search Plan and Results: CI: Blood Glucose 2006
     
  What impact does blood glucose control have on length of hospital stay in critically ill patients?

  • Conclusion

    There is fair evidence that controlling BG values in critically ill patients leads to a decrease in ICU LOS.

  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: Blood Glucose Control: LOS
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Krinsley JS and Jones RL, Cost analysis of initensive glycemic control in critically ill adult patients. Chest. 2006. 129:644-650.
      • Krinsley JS Effect of an intensive glucose management protocol on the mortality of critically ill patients. Mayo Clin Proc Nov 15, 2004. 2004;79(8):992-1000.
      • Van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P and Bouillon R. Intensive Insulin Therapy in Critically Ill Patients. NEJM. 2001;345(19):1359-1367.
  • Search Plan and Results: CI: Blood Glucose 2006
     
  What impact does blood glucose control have on days on mechanical ventilation in critically ill patients?

  • Conclusion

    There is fair evidence that controlling BG values in critically ill patients is associated with reduced number of days on mechanical ventilation.

  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: Blood Glucose Control: Days on Mechanical Ventilation
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Krinsley JS and Jones RL, Cost analysis of initensive glycemic control in critically ill adult patients. Chest. 2006. 129:644-650.
      • Van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P and Bouillon R. Intensive Insulin Therapy in Critically Ill Patients. NEJM. 2001;345(19):1359-1367.
      • Van den Berghe G, Wilmer A, Hermans G, Meersseman W, Wouters PJ, Milants I, Wijngaerden EV, Bobbaers H, Bouillon R. Intensive insulin therapy in the medical icu. N Engl J Med 2006; 354:449-61.  
  • Search Plan and Results: CI: Blood Glucose 2006
     
  What impact does blood glucose control have on cost of medical care in critically ill patients?

  • Conclusion

    There is limited evidence that controlling BG values in critically ill patients leads to a decrease in the cost of medical care.

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: Blood Glucose Control: Cost of Medical Care
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Krinsley JS and Jones RL, Cost analysis of initensive glycemic control in critically ill adult patients. Chest. 2006. 129:644-650.
  • Search Plan and Results: CI: Blood Glucose 2006