Tight glycaemic control in the intensive care unit pitfalls in the testing of the concept 英文参考文献.docVIP

Available online /content/12/5/187 Commentary Tight glycaemic control in the intensive care unit: pitfalls in the testing of the concept Dieter Mesotten Department of Intensive Care Medicine, Catholic University of Leuven, University Hospital Leuven, Herestraat 49, B-3000 Leuven, Belgium Corresponding author: Dieter Mesotten, dieter.mesotten@med.kuleuven.be Published: 24 October 2008 Critical Care 2008, 12:187 (doi:10.1186/cc7086) This article is online at /content/12/5/187 ? 2008 BioMed Central Ltd See related research by De La Rosa et al., /content/12/5/R120 Abstract over implementation studies, which showed a benefit of tight glycaemic control but are substandard to assess effective- ness of a therapy [4]. The overall methodological quality was adequate with regard to randomisation, allocation conceal- ment, intention-to-treat analysis, and completeness of follow- up. The slight differences in study population, such as the proportion of patients post-cardiac surgery and the on- admission APACHE (Acute Physiology and Chronic Health Evaluation) II score, are probably of minor importance. The pitfalls that matter may hide beneath the surface. Tight glycaemic control emerged on the scene of critical care in Surprisingly, not many confirmation trials have been published so far. The randomised controlled trial by De La Rosa and colleagues is a timely and valuable attempt to repeat the landmark Leuven studies. The failure to replicate the beneficial effects of tight glycaemic control may boil down to some less obvious defaults in the set-up of the trial despite a seemingly 2001. adequate study design. The incorporation of ample power calculations and strict adherence to glucose targets are essential to fairly compare studies on tight blood glucose control. Only if these basic conditions of study design are fulfilled