ABSTRACT

This study was planned in order to search the effect of tight blood glucose level control with continuing insulin infusion on mortality, morbidity and immune paralysis among critically ill patients.

This prospective randomized study was conducted on 20 patients after approval from all patients or first-degree relatives were obtained on admission to intensive care unit (ICU). On admission, the patients were randomly assigned to Intensive Insulin Therapy (IIT) or Conventional Insulin Therapy (CIT) Groups. Each group involved 10 patients. In IIT Group, we tried to maintain blood glucose levels between 80-110 mg/dL via continuous insulin infusion; whereas blood glucose level was maintained between 180-200 mg/dL in CIT Group. After admission, APACHE II (Acute Physiology and Chronic Health Evaluation II) and TISS 28 (Therapeutic Intervention Scoring System) scores were calculated daily. Complete blood count, blood chemistry analyzes CRP (C-reaktive protein) levels and monocytic HLA- DR levels were determined on admission, 5th, 14th and 28th days. The length of stay in intensive care unit and in hospital were also recorded in addition to the possible cause and time of mortalities. Were performed for statistical analyzes Mann Whitney U and Chi-Square Test. The p values less than 0.05 were considered as statistically significant.

The tranfusion requirement, blood glucose levels at 6 a.m. and daily minimal and maximal glucose levels were found to be lower in the IIT Group (p 0.05). Although intensive insulin therapy reduced intensive care unit mortality by 20% and hospital mortality by 30%, these variables were not considered to be statistically significant. In addition, this study showed that intensive insulin therapy reduced lengths of intensive care unit and hospital stay, inotropic treatment, renal replacement therapy requirement, hyperbilirubinemia and blood stream infection; however these differences were not statistically insignificant. We could not show important effect of intensive insulin therapy upon monocyte HLA-DR and CRP levels.

There were no difference between IIT or CIT Groups in terms of mortality and immun paralysis. The tranfusion requirement, blood glucose levels at 6 a.m. and daily minimal and maximal glucose levels were significantly lower in IIT Group (p<0.05).

Keywords: Criticall illness, Stress response, Hyperglycemia, İntensive insulin therapy, Tight glucose control