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Adigbli D, Yang L, Hammond N, Annane D, Arabi Y, Bilotta F, Bohé J, Brunkhorst FM, Cavalcanti AB, Cook D, Engel C, Green-LaRoche D, He W, Henderson W, Hoedemaekers C, Iapichino G, Kalfon P, Rosa GDL, MacKenzie I, Mélot C, Mitchell I, Oksanen T, Polli F, Preiser JC, Soriano FG, Wang LC, Yuan J, Delaney A, Tanna GLD, Finfer S. Intensive glucose control in critically ill adults: a protocol for a systematic review and individual patient data meta-analysis. Crit Care Sci 2023; 35:345-354. [PMID: 38265316 PMCID: PMC10802778 DOI: 10.5935/2965-2774.20230162-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/06/2023] [Indexed: 01/25/2024]
Abstract
OBJECTIVE The optimal target for blood glucose concentration in critically ill patients is unclear. We will perform a systematic review and meta-analysis with aggregated and individual patient data from randomized controlled trials, comparing intensive glucose control with liberal glucose control in critically ill adults. DATA SOURCES MEDLINE®, Embase, the Cochrane Central Register of Clinical Trials, and clinical trials registries (World Health Organization, clinical trials.gov). The authors of eligible trials will be invited to provide individual patient data. Published trial-level data from eligible trials that are not at high risk of bias will be included in an aggregated data meta-analysis if individual patient data are not available. METHODS Inclusion criteria: randomized controlled trials that recruited adult patients, targeting a blood glucose of ≤ 120mg/dL (≤ 6.6mmol/L) compared to a higher blood glucose concentration target using intravenous insulin in both groups. Excluded studies: those with an upper limit blood glucose target in the intervention group of > 120mg/dL (> 6.6mmol/L), or where intensive glucose control was only performed in the intraoperative period, and those where loss to follow-up exceeded 10% by hospital discharge. PRIMARY ENDPOINT In-hospital mortality during index hospital admission. Secondary endpoints: mortality and survival at other timepoints, duration of invasive mechanical ventilation, vasoactive agents, and renal replacement therapy. A random effect Bayesian meta-analysis and hierarchical Bayesian models for individual patient data will be used. DISCUSSION This systematic review with aggregate and individual patient data will address the clinical question, 'what is the best blood glucose target for critically ill patients overall?'Protocol version 0.4 - 06/26/2023PROSPERO registration:CRD42021278869.
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Affiliation(s)
- Derick Adigbli
- Critical Care Division, The George Institute for Global Health -
New South Wales, Australia
| | - Li Yang
- Critical Care Division, The George Institute for Global Health -
New South Wales, Australia
| | - Naomi Hammond
- Critical Care Division, The George Institute for Global Health -
New South Wales, Australia
| | | | - Yaseen Arabi
- Intensive Care Department, Medical Director of Respiratory
Services, King Saud Bin Abdulaziz University for Health Sciences - Riyadh, Saudi
Arabia
| | - Federico Bilotta
- Department of Anesthesiology, Critical Care and Pain Medicine,
Policlinico Umberto I, Sapienza University of Rome - Rome, Italy
| | - Julien Bohé
- Service d’Anesthésie-Réanimation-Médecine
Intensive, Groupement Hospitalier Sud, Hospices Civils de Lyon,
Pierre-Bénite, France
| | - Frank Martin Brunkhorst
- Department of Anaesthesiology and Intensive Care Medicine, Jena
University Hospital - Jena, Germany
| | | | - Deborah Cook
- Critical Care Medicine, St Joseph’s Healthcare Hamilton - Ontario,
Canada
| | - Christoph Engel
- Institute for Medical Informatics, Statistics and Epidemiology,
Leipzig University, Leipzig, Germany
| | | | - Wei He
- Department of Critical Care Medicine, Beijing Tong Ren Hospital,
Capital Medical University - Beijing, China
| | - William Henderson
- VA Emergency Operations Centre, UBC Hospital, University of
British Columbia - Columbia, Canada
| | - Cornelia Hoedemaekers
- Department of Critical Care, Radboud University Nijmegen Medical
Centre -Nijmegen, The Netherlands
| | - Gaetano Iapichino
- Anestesiologia e Rianimazione, Universitá degli Studi di
Milano - Milano, Italy
| | | | - Gisela de La Rosa
- Intensive Care Department, Hospital Pablo Tobon Uribe - Medellin,
Colombia
| | - Iain MacKenzie
- InterSystems Corporation - Cambridge, Mass. , United States
| | | | | | - Tuomas Oksanen
- Department of Anesthesiology and Intensive Care, Helsinki
University Hospital and University of Helsinki - Helsinki, Finland
| | | | | | - Francisco Garcia Soriano
- Department of Critical Care Medicine, Hospital das Clinicas,
Universidade de São Paulo - São Paulo, Brazil
| | - Ling-Cong Wang
- Intensive Care Unit, The First Affiliated Hospital of Zhejiang
Traditional Chinese Medical University - Zhejiang, China
| | - Jiaxiang Yuan
- Department of Laparoscopic Surgery, The First Affiliated Hospital
of Zhengzhou University - Zhengzhou, China
| | - Anthony Delaney
- Critical Care Division, The George Institute for Global Health -
New South Wales, Australia
| | - Gian Luca Di Tanna
- Critical Care Division, The George Institute for Global Health -
New South Wales, Australia
| | - Simon Finfer
- Critical Care Division, The George Institute for Global Health -
New South Wales, Australia
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Ortíz G, Dueñas C, Rodríguez F, Barrera L, de La Rosa G, Dennis R, Granados M, Londoño D, Molina F, Jaimes F. Epidemiology of sepsis in Colombian intensive care units. Biomedica 2015; 34:40-7. [PMID: 24967858 DOI: 10.1590/s0120-41572014000100007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 07/26/2013] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Currently, there is not enough data available concerning sepsis in developing countries, especially in Latin America. OBJECTIVE We developed a study aimed at determining the frequency, clinical and epidemiological characteristics, and the consequences of sepsis in patients requiring admission to intensive care units in Colombia. MATERIALS AND METHODS This was a secondary analysis of a prospective cohort study carried out over a six-month period, from September 1, 2007, to February 28, 2008, in ten medical/surgical intensive care units in four Colombian cities. Patients were considered eligible if they had a probable or confirmed diagnosis of infection according to medical records. We recorded demographic characteristics, first admission diagnosis and co-morbidities, clinical status, and sepsis, severe sepsis or septic shock. RESULTS During the study period, 826 patients were admitted to the intensive care units. From these patients, 421 (51%) developed sepsis in the community, 361 (44%) in the ICU, and 44 (5%) during hospitalization in the general ward. Two hundred and fifty three patients (30.6%) had involvement of one organ system: 20% had respiratory involvement, followed by kidney and central nervous system involvement with 3.4% and 2.7%, respectively. CONCLUSIONS In our cohort of septic patients, the prevalence of sepsis treated in ICU is similar to that reported in other studies, as well as the overall mortality.
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Affiliation(s)
- Guillermo Ortíz
- Departamento de Cuidado Intensivo, Hospital Santa Clara, Bogotá, D.C, Colombia
| | - Carmelo Dueñas
- Departamento de Cuidado Intensivo, Hospital Bocagrande, Cartagena, Colombia
| | - Ferney Rodríguez
- Departamento de Medicina Interna, Universidad de Antioquia, Medellín, Colombia
| | - Lena Barrera
- Departamento de Epidemiología, Universidad del Valle, Cali, Cali, Colombia
| | - Gisela de La Rosa
- Departamento de Cuidado Intensivo, Hospital Pablo Tobón Uribe, Medellín, Colombia
| | - Rodolfo Dennis
- Departamento de Medicina Interna, Fundación Cardio-Infantil, Bogotá, D.C, Colombia
| | - Marcela Granados
- Departamento de Cuidado Intensivo, Fundación Valle de Lili, Cali, Cali, Colombia
| | - Darío Londoño
- Departamento de Cuidado Intensivo, Pontificia Universidad Javeriana, Bogotá, D.C, Colombia
| | - Francisco Molina
- Departamento de Cuidado Intensivo, Universidad Pontificia Bolivariana
| | - Fabián Jaimes
- Departamento de Cuidado Intensivo, Universidad de Antioquia
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