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Meng J, Li X, Xiao Y, Tang H, Liu P, Wu Y, Xiong Y, Gao S. Intensive or liberal glucose control in intensive care units for septic patients? A meta-analysis of randomized controlled trials. Diabetes Metab Syndr 2024; 18:103045. [PMID: 38796958 DOI: 10.1016/j.dsx.2024.103045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 05/21/2024] [Accepted: 05/22/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVE To compare the clinical outcomes of intensive glucose control and liberal glucose control for septic patients in intensive care unit. METHODS The databases of PubMed, Cochrane Library, Embase and Web of Science were searched systematically from inception to November 27, 2023 to identify trials involving a randomized comparison between intensive and liberal glucose control for septic patients in intensive care unit. RESULTS A total of 14 randomized controlled trials involving 6226 patients were finally included. There was no statistically significant difference observed between intensive glucose control and liberal glucose control in terms of all-cause mortality, the need for renal replacement, vasopressor-free and mechanical ventilation-free days, and length of hospital stay. However, it is noteworthy that intensive glucose control exhibited a statistically higher risk of severe hypoglycemia (RR 2.66; 95%CI 1.85 to 3.83), need for blood transfusion (RR 1.12; 95%CI 1.01 to 1.23), and statistically prolonged length of stay in the ICU (MD 1.67; 95%CI 0.22 to 3.12) compared to liberal glucose control. Nevertheless, sensitivity analysis revealed that the need for blood transfusion and length of stay in the intensive care unit were not robust. CONCLUSIONS Both intensive and liberal glucose control had comparable effects on improving patient outcomes, but intensive glucose control carried a higher risk of severe hypoglycemia.
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Affiliation(s)
- Jiahao Meng
- Department of Orthopaedics, Xiangya Hospital Central South University, #87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Xi Li
- Department of Orthopaedics, Xiangya Hospital Central South University, #87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Yifan Xiao
- Department of Orthopaedics, Xiangya Hospital Central South University, #87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Hang Tang
- Department of Orthopaedics, Xiangya Hospital Central South University, #87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Pan Liu
- Department of Orthopaedics, Xiangya Hospital Central South University, #87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Yumei Wu
- Department of Orthopaedics, Xiangya Hospital Central South University, #87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Yilin Xiong
- Department of Orthopaedics, Xiangya Hospital Central South University, #87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Shuguang Gao
- Department of Orthopaedics, Xiangya Hospital Central South University, #87 Xiangya Road, Changsha, 410008, Hunan, China; Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China; Hunan Engineering Research Center of Osteoarthritis, Changsha, Hunan, China; National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.
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Brinati LM, de Fátima Januário C, Balbino PC, Gonçalves Rezende Macieira T, Cardoso SA, Moreira TR, de Oliveira Salgado P. Incidence and Prediction of Unstable Blood Glucose Level among Critically Ill Patients: A Cohort Study. Int J Nurs Knowl 2020; 32:96-102. [PMID: 32706490 DOI: 10.1111/2047-3095.12299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 01/18/2023]
Abstract
PURPOSE To evaluate the incidence and the prediction of unstable blood glucose level among critically ill patients hospitalized in an intensive care unit. METHODS A cohort study was conducted with 62 adult patients hospitalized at an intensive care unit of a hospital located in Minas Gerais, Brazil, between March and July of 2017. Patient's demographic information, along with scores for Simplified Acute Physiology Score III, primary medical diagnosis, discharge status, diagnosis of diabetes and/or sepsis, length of stay, glycemic variability, type of nutrition, types of medications and treatments, and oxygen therapy were collected daily. A daily venous blood sample was collected to measure blood glucose levels during the patient's hospitalization period. Bivariate analysis was used to explore the association among the potential diagnostic indicators and the outcome of unstable blood glucose levels. Multivariate Cox regression was used to identify the potential predictors for the outcome. FINDINGS Of the total of 62 participants, 45.1% (n=28) had unstable blood glucose level. Among the 28 patients with unstable blood glucose levels, half of them (n=14, 50%) had hypoglycemia and the other half had hyperglycemia (n=14, 50%). Decreased number of days hospitalized and the use of intensive glucose control with regular insulin were associated with decreased odds of developing hyperglycemia. The presence of mechanical ventilation was associated with a higher risk for the development of hypoglycemia. CONCLUSIONS This study provides knowledge and evidence of diagnostic indicators for unstable blood glucose levels that are not currently included in the NANDA-International terminology for the nursing diagnosis Risk for unstable blood glucose level (00179). IMPLICATIONS FOR NURSING PRACTICE This study identified important diagnostic indicators that nurses can observe during the assessment to identify patients that are at risk for developing unstable blood glucose level and provide the appropriate care.
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Affiliation(s)
- Lídia Miranda Brinati
- Lídia Miranda Brinati, MSN, RN, is in, Centro de Terapia Intensiva Adulto Casa de Caridade de Viçosa Hospital São Sebastião, Viçosa, MG, Brazil
| | | | - Paula Coelho Balbino
- Paula Coelho Balbino, RN, is in, Núcleo de Segurança do Paciente Hospital São João Batista, Viçosa, MG, Brazil
| | - Tamara Gonçalves Rezende Macieira
- Tamara Gonçalves Rezende Macieira, PhD, RN, is an Assistant Professor in College of Nursing, University of Florida, Gainesville, Florida
| | - Silvia Almeida Cardoso
- Silvia Almeida Cardoso, PhD, is an Assistant Professor in Department of Medicine and Nursing, Federal University of Viçosa (UFV), Viçosa, MG, Brazil
| | - Tiago Ricardo Moreira
- Tiago Ricardo Moreira, PhD, is an Assistant Professor in Department of Medicine and Nursing, Federal University of Viçosa (UFV), Viçosa, MG, Brazil
| | - Patrícia de Oliveira Salgado
- Patrícia de Oliveira Salgado, PhD, RN, is an Assistant Professor in Department of Medicine and Nursing, Federal University of Viçosa (UFV), Viçosa, MG, Brazil
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Yao RQ, Ren C, Wu GS, Zhu YB, Xia ZF, Yao YM. Is intensive glucose control bad for critically ill patients? A systematic review and meta-analysis. Int J Biol Sci 2020; 16:1658-1675. [PMID: 32226310 PMCID: PMC7097913 DOI: 10.7150/ijbs.43447] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 02/27/2020] [Indexed: 02/07/2023] Open
Abstract
Background: The monitoring and management of blood glucose concentration are standard practices in critical settings as hyperglycaemia has been shown close association with poorer outcomes. Several meta-analyses have revealed that intensive glucose control has no benefit in decreasing short-term mortality among critically ill patients, while the studies these meta-analyses have incorporated have been largely divergent. We aim to perform a more comprehensive meta-analysis addressing this problem to provide stronger evidence. Methods: We conducted comprehensive searches for relevant randomized controlled studies in online databases, including the Cochrane Library, EMBASE, and PubMed databases, up to September 1, 2018. The clinical data, which included all-cause mortality, severe hypoglycemia, need for RRT, infection resulting in sepsis, ICU mortality, 90-day mortality, 180-day mortality, and hospital and ICU lengths of stay, were screened and analyzed after data extraction. We applied odds ratios (ORs) to analyze dichotomous outcomes and mean differences for continuous outcomes with a random effects model. Results: A total of 57 RCTs involving a total of 21840 patients were finally included. Patients admitted to the ICU who underwent intensive glucose control showed significantly reduced all-cause mortality (OR: 0.89; 95% CI: 0.80-1.00; P=0.04; I2=32%), reduced infection rate (OR: 0.65, 95% CI: 0.51-0.82, P=0.0002; I2=47%), a lower occurrence of acquired sepsis (OR: 0.80, 95% CI: 0.65-0.99, P=0.04; I2=0%) and shortened length of ICU stay (MD: -0.70, 95% CI: -1.21--0.19, P=0.007, I2=70%) when compared to the same parameters as those treated with the usual care strategy. However, patients in the intensive glucose control group presented with a significantly higher risk of severe hypoglycemia (OR: 5.63, 95% CI: 4.02-7.87, P<0.00001; I2=67%). Conclusions: Critically ill patients undergoing intensive glucose control showed significantly reduced all-cause mortality, length of ICU stay and incidence of acquired infection and sepsis compared to the same parameters in patients treated with the usual care strategy, while the intensive glucose control strategy was associated with higher occurrence of severe hypoglycemic events.
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Affiliation(s)
- Ren-qi Yao
- Trauma Research Center, Fourth Medical Center of the Chinese PLA General Hospital, Beijing 100048, People's Republic of China
- Department of Burn Surgery, Changhai Hospital, the Second Military Medical University, Shanghai 200433, People's Republic of China
| | - Chao Ren
- Trauma Research Center, Fourth Medical Center of the Chinese PLA General Hospital, Beijing 100048, People's Republic of China
| | - Guo-sheng Wu
- Department of Burn Surgery, Changhai Hospital, the Second Military Medical University, Shanghai 200433, People's Republic of China
| | - Yi-bing Zhu
- Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing 100038, People's Republic of China
| | - Zhao-fan Xia
- Department of Burn Surgery, Changhai Hospital, the Second Military Medical University, Shanghai 200433, People's Republic of China
| | - Yong-ming Yao
- Trauma Research Center, Fourth Medical Center of the Chinese PLA General Hospital, Beijing 100048, People's Republic of China
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Crespo JCL, Gomes VR, Barbosa RL, Padilha KG, Secoli SR. Haemodialysis, nutritional disorders and hypoglycaemia in critical care. ACTA ACUST UNITED AC 2017; 26:281-286. [PMID: 28328262 DOI: 10.12968/bjon.2017.26.5.281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This study aimed to determine hypoglycemia incidence and associated factors in critically ill patients. It looked at a retrospective cohort with 106 critically ill adult patients with 48 hours of glycaemic control and 72 hours of follow up. The dependent variable, hypoglycaemia (≤70 mg/dl), was assessed with respect to independent variables: age, diet, insulin, catecholamines, haemodialysis, nursing workload and the Simplified Acute Physiology Score. Statistical analysis was performed using Student's t-test, Fisher's exact test and logistic regression at 5% significance level. Incidence of hypoglycaemia was 14.2%. Hypoglycaemia was higher in the group of patients on catecholamines (p=0.040), with higher glycaemic variability (p<0.001) and death in the intensive care unit (p=0.008). Risk factors were identified as absence of oral diet (OR 5.11; 95% CI 1.04-25.10) and haemodialysis (OR 4.28; 95% CI 1.16-15.76). Patients on haemodialysis and with no oral diet should have their glycaemic control intensified in order to prevent and/or manage hypoglycaemic episodes.
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Affiliation(s)
- Jeiel Carlos Lamonica Crespo
- Nursing Department, Instituto do Coração (Heart Institute), Hospital das Clínicas da Escola de Medicina da Universidade de São Paulo, Brazi
| | - Vanessa Rossato Gomes
- Nursing Department, Instituto do Coração (Heart Institute), Hospital das Clínicas da Escola de Medicina da Universidade de São Paulo, Brazil
| | | | - Katia Grillo Padilha
- Medical-Surgical Nursing Department, Escola de Enfermagem da Universidade de São Paulo, Brazil
| | - Silvia Regina Secoli
- Medical-Surgical Nursing Department, Escola de Enfermagem da Universidade de São Paulo, Brazil
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