What are the benefits of intensive glycemic control in patients with systemic inflammatory response syndrome (SIRS)?

Updated: May 07, 2018
  • Author: Lewis J Kaplan, MD, FACS, FCCM, FCCP; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM  more...
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Answer

Intensive control of blood glucose levels has been shown to diminish in-hospital morbidity and mortality in the surgical and medical intensive care setting. Various trials have demonstrated that glycemic control with insulin improves patient outcomes (including renal function and acute renal failure), reduces the need for red blood cell transfusions, reduces the number of days in the ICU, lowers the incidence of critical-illness polyneuropathy, and decreases the need for prolonged mechanical ventilation.

Van den Berghe et al reported a reduction of in-hospital mortality rates with intensive insulin therapy (maintenance of blood glucose at 80-110 mg/dL) by 34%. [30] The greatest reduction in mortality involved deaths due to multiple-organ failure with a proven septic focus. Subsequent studies by this group and others have failed to demonstrate distinct outcome benefit from such tight glucose control, mainly because the complication rate for hypoglycemia and hypokalemia complicate its effects. Presently, the Surviving Sepsis guidelines recommend keeping glucose levels at less than 180 mg/dL. [26]


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