, Volume 13, Issue 3, pp 295-298
Date: 23 Oct 2010

Intensive Versus Conventional Insulin Therapy in Critically Ill Neurologic Patients: Still Searching for the Sweet Spot

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There are very few treatments in the world of critical care that have been shown to reduce mortality in well constructed randomized controlled trials. In fact, only therapeutic hypothermia after cardiac arrest, goal directed therapy for sepsis, low tidal volumes in ALI/ARDS, recombinant activated protein C in sepsis, and early tracheostomy in critically ill medical patients have substantial support in the literature [16]. Until recently, intensive glucose control was counted among this small group of therapeutic tools within the intensivist’s arsenal.

In 2001, the landmark van den Berghe single-center SICU trial [7] generated intense interest when it revealed a reduction in ICU mortality from 8% in the conventional group to 4.6% in the intensive insulin group (P = 0.005), using intensive insulin infusion targeted to a blood glucose of 80–110 mg/dl compared to conventional insulin infusion initiated for a blood glucose >215 mg/dl and targeted to 180–200 mg/dl. This study additionally de