Intensive Care Medicine

, Volume 40, Issue 2, pp 171–181 | Cite as

Tight computerized versus conventional glucose control in the ICU: a randomized controlled trial

  • Pierre Kalfon
  • Bruno Giraudeau
  • Carole Ichai
  • Alexandre Guerrini
  • Nicolas Brechot
  • Raphaël Cinotti
  • Pierre-François Dequin
  • Béatrice Riu-Poulenc
  • Philippe Montravers
  • Djilalli Annane
  • Hervé Dupont
  • Michel Sorine
  • Bruno Riou
  • On behalf of the CGAO–REA Study Group
Seven-Day Profile Publication

Abstract

Purpose

The blood glucose target range and optimal method to reach this range remain a matter of debate in the intensive care unit (ICU). A computer decision support system (CDSS) might improve the outcome of ICU patients through facilitation of a tighter blood glucose control.

Methods

We conducted a multi-center randomized trial in 34 French ICU. Adult patients expected to require treatment in the ICU for at least 3 days were randomly assigned without blinding to undergo tight computerized glucose control with the CDSS (TGC) or conventional glucose control (CGC), with blood glucose targets of 4.4–6.1 and <10.0 mmol/L, respectively. The primary outcome was all-cause death within 90 days after ICU admission.

Results

Of the 2,684 patients who underwent randomization to the TGC and CGC treatment groups, primary outcome was available for 1,335 and 1,311 patients, respectively. The baseline characteristics of these treatment groups were similar in terms of age (61 ± 16 years), SAPS II (51 ± 19), percentage of surgical admissions (40.0 %) and proportion of diabetic patients (20.3 %). A total of 431 (32.3 %) patients in the TGC group and 447 (34.1 %) in the CGC group had died by day 90 (odds ratio for death in the TGC 0.92; 95 % confidence interval 0.78–1.78; p = 0.32). Severe hypoglycemia (<2.2 mmol/L) occurred in 174 of 1,317 patients (13.2 %) in the TGC group and 79 of 1,284 patients (6.2 %) in the CGC group (p < 0.001).

Conclusions

Tight computerized glucose control with the CDSS did not significantly change 90-day mortality and was associated with more frequent severe hypoglycemia episodes in comparison with conventional glucose control.

Keywords

Critical care Glucose control Computerized decision-support systems ICU Mortality Randomized controlled trials 

Supplementary material

134_2013_3189_MOESM1_ESM.doc (24 kb)
Supplementary material 1 (DOC 23 kb)
134_2013_3189_MOESM2_ESM.doc (700 kb)
Supplementary material 2 (DOC 700 kb)
134_2013_3189_MOESM3_ESM.doc (24 kb)
Supplementary material 3 (DOC 24 kb)
134_2013_3189_MOESM4_ESM.doc (30 kb)
Supplementary material 4 (DOC 30 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2013

Authors and Affiliations

  • Pierre Kalfon
    • 1
    • 2
  • Bruno Giraudeau
    • 3
  • Carole Ichai
    • 4
  • Alexandre Guerrini
    • 5
    • 6
  • Nicolas Brechot
    • 7
  • Raphaël Cinotti
    • 8
  • Pierre-François Dequin
    • 9
  • Béatrice Riu-Poulenc
    • 10
  • Philippe Montravers
    • 11
  • Djilalli Annane
    • 12
  • Hervé Dupont
    • 13
  • Michel Sorine
    • 6
  • Bruno Riou
    • 2
    • 14
  • On behalf of the CGAO–REA Study Group
  1. 1.Service de Réanimation polyvalente, Hôpital Louis Pasteur Hôpitaux de ChartresChartres CedexFrance
  2. 2.UMR INSERM 956Université Pierre et Marie CurieParisFrance
  3. 3.INSERM CIC (Centre d’investigation clinique) 202Centre Hospitalier Universitaire (CHU) de ToursToursFrance
  4. 4.Service de Réanimation médico-chirurgicale, Hôpital Saint-RochCHU de NiceNiceFrance
  5. 5.LK2Saint-AvertinFrance
  6. 6.Institut National de Recherche en Informatique et en Automatique (INRIA)RocquencourtFrance
  7. 7.Service de Réanimation médicale, Institut de Cardiologie, CHU Pitié-SalpêtrièreAssistance Publique-Hôpitaux de Paris (AP-HP)ParisFrance
  8. 8.Service de Réanimation chirurgicale cardio-thoracique et vasculaire, Hôpital LaennecCHU de NantesNantesFrance
  9. 9.Service de Réanimation médicale, Hôpital BretonneauCHRU de ToursToursFrance
  10. 10.Service de Réanimation polyvalente, Hôpital PurpanCHU de ToulouseToulouseFrance
  11. 11.Département d’Anesthésie et Réanimation chirurgicale, CHU Bichat-Claude Bernard AP-HPParisFrance
  12. 12.Service de RéanimationCHU Raymond Poincaré, AP-HPGarchesFrance
  13. 13.Service d’Anesthésie Réanimation, Hôpital NordCHRU AmiensAmiensFrance
  14. 14.Service d’accueil des Urgences, CHU Pitié-Salpêtrière AP-HPParisFrance

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