Possible Complications of Critically Ill Patients

Patients who need intensive care for more than five days have a 20% chance of dying, aside from suffering a lot of accompanying illnesses like sudden limb and respiratory weakness that can prolong the need for mechanical life support. They are also more likely to get severe infections and have vital organs failing, further decreasing survival chances.

Critically ill patients often have hyperglycemia (or high blood sugar level), even if they have not had diabetes before. Some people think this might lead to complications, but there is no proof of this yet.

For those with diabetes and who have had a heart attack, keeping blood sugar levels below 215 mg/dL (11.9 mmol/L) improves the long-term outcome. In nondiabetic patients with a long illness, high levels of insulin-like growth factor-binding protein 1, a protein that reflects a defective liver response to insulin, may increase the risk of death.

We hypothesize that hyperglycemia, lack of insulin, or both during a critical illness, could make one more likely to have: - Serious infections

• Nerve problems - Multiple organ failures
• And even die

So we did a study to see if giving intensive insulin therapy to normalize blood sugar levels would reduce mortality and morbidity among critically ill patients.

The Study Method on Intensive Insulin Therapy for Critically Ill Patients

We performed a randomized, controlled study involving surgical ICU patients on life support. Upon admission, patients were assigned at random to receive one of 2 treatments. They would either receive intensive insulin therapy, which maintains the blood glucose at 80-110 milligrams (mg)/deciliter. Or they would receive conventional treatment wherein insulin was given when the blood glucose level exceeded 215 mg/deciliter and maintained at levels between 180 and 200 mg/deciliter.

Blood glucose levels were measured every four hours upon admission to determine if blood sugar was controlled. Blood cultures were also taken whenever the person’s temperature exceeded 38.5 degrees Celsius to check the presence of bacteria. Weekly electromyographic screenings were performed among patients who remained in the ICU for a week or more to test for polyneuropathy (malfunction of nerves throughout the body).

The Results

The study was conducted for one year, with 1,548 patients participating. With intensive insulin therapy, the mortality rate while in ICU was reduced from 8% with conventional treatment to 4.6%. This could be attributed to the mortality rate among patients who stayed in the ICU for more than five days (20.2 % with conventional treatment, compared to only 10.6 % with intensive insulin therapy).

The most significant reduction in mortality involved deaths due to multiple-organ failure. Intensive insulin therapy also lessened overall in-hospital mortality by 34%, bloodstream infections by 46%, acute renal failure requiring dialysis by 41%, the number of red cell transfusions by 50%, and polyneuropathy by 44%. Patients who received intensive therapy were less likely to require prolonged mechanical ventilation and intensive care.

The Conclusion

Intensive insulin therapy that would maintain blood glucose below 110 mg/deciliter can lessen mortality and morbidity rates of critically ill patients in the surgical intensive care unit.

Reference

Intensive Insulin Therapy in Critically Ill Patients