Does intensive insulin therapy really reduce mortality in critically ill surgical patients A reanalysis of meta-analytic data.docVIP

Friedrich et al. Critical Care 2010,14:324 /content/14/5/324 VIEWPOINT Does intensive insulin therapy really reduce mortality in critically ill surgical patients? A reanalysis of meta-analytic data Jan O Friedrich *, Clarence Chant and Neill KJ Adhikari 1,2,3 4 1,5 Introduction Abstract Two recent systematic reviews that evaluated intensive insulin therapy (IIT) in critically ill patients grouped the included randomized controlled trials (RCTs) by type of intensive care unit (ICU): surgical versus medical versus mixed medical–surgical [1,2]. Both reviews found no Two recent systematic reviews evaluating intensive insulin therapy (IIT) in critically ill patients grouped randomized controlled trials (RCTs) by type of intensive care unit (ICU). The more recent review found that IIT reduced mortality in patients admitted to a surgical ICU, but not in those admitted to medical ICUs mortality reduction among all critically ill patients e more recent review by Griesdale and colleagues, however, found that IIT reduced mortality in patients admitted to surgical ICUs, but not in patients admitted to medical ICUs or mixed medical–surgical ICUs [2]. Potential explanations to support the bene? cial e? ects of IIT among critically ill surgical patients were proposed in the accompanying editorial: a greater use of central and arterial lines in surgical ICUs, which allows for more accurate monitoring and correc tion of blood glucose; acute hyperglycemia in surgical patients, who are more likely to bene? t from correction than medical patients with chronic elevations and adap tive responses; and better achievement of target glucose levels in surgical ICU studies compared with medical ICU or mixed ICU studies [3]. In contrast to the ? nding of the most rec