Journal Article

Intensive Insulin Therapy and Pentastarch Resuscitation in Severe Sepsis

Brunkhorst, Frank M, Kiehntopf, Michael, Hartog, Christiane, Olthoff, Derk, Oppert, Michael, Bloos, Frank, Gruendling, Matthias, Engel, Christoph, Grond, Stefan, Rossaint, Rolf, Welte, Tobias, Ragaller, Max, Reinhart, Konrad, Kuhnt, Evelyn, Natanson, Charles, Moerer, Onnen, Jaschinski, Ulrich, Weiler, Norbert, Kern, Peter, Meier-Hellmann, Andreas, John, Stefan, Schaefer, Martin, Loeffler, Markus

2008

Overview

Optimal glucose control and fluid resuscitation in patients with septic shock remain a challenge. In this study involving more than 500 patients, the potential benefit of maintaining euglycemia through intensive insulin therapy and optimal fluid resuscitation with either pentastarch or Ringer's lactate was assessed. There was no benefit in the intensive-therapy group with respect to either 28-day survival or organ function; there was more severe hypoglycemia in the intensive-therapy group and more acute renal failure in the pentastarch group. The potential benefit of maintaining euglycemia through intensive insulin therapy and optimal fluid resuscitation was assessed. There was no benefit in the intensive-therapy group with respect to either 28-day survival or organ function. In a study by Van den Berghe et al. involving critically ill surgical patients, intensive insulin therapy to maintain euglycemia (glucose level, 80 to 110 mg per deciliter [4.4 to 6.1 mmol per liter]) lowered in-hospital mortality from 10.9% to 7.2%, mostly by reducing deaths from multiple organ failure with a proven septic focus. 1 This beneficial effect occurred predominantly in cardiac surgical patients who received high glucose challenges immediately after surgery (8 to 12 g of glucose intravenously per hour) and was associated with an unusually high rate of death (5.1%) among controls. Furthermore, in a follow-up study by Van . . .

• Publisher: Massachusetts Medical Society
• Subject: Acute Kidney Injury - etiology / Aged / Bacterial diseases / Bacterial sepsis / Biological and medical sciences / Combined Modality Therapy / Consent / Critical Illness / Diabetes / Dose-Response Relationship, Drug / Female / Fluid Therapy / General aspects / Glucose / Human bacterial diseases / Humans / Hydroxyethyl Starch Derivatives - administration & dosage / Hydroxyethyl Starch Derivatives - adverse effects / Hydroxyethyl Starch Derivatives - therapeutic use / Hypoglycemia - chemically induced / Hypoglycemic Agents - administration & dosage / Hypoglycemic Agents - adverse effects / Infectious diseases / Infusions, Intravenous / Insulin / Insulin - administration & dosage / Insulin - adverse effects / Isotonic Solutions - adverse effects / Isotonic Solutions - therapeutic use / Kaplan-Meier Estimate / Male / Medical sciences / Middle Aged / Multivariate Analysis / Risk Factors / Sepsis / Sepsis - drug therapy / Sepsis - mortality / Sepsis - therapy / Treatment Failure