Intensive insulin treatment improves forearm blood flow in critically ill patients : a randomized parallel design clinical trial [Elektronski vir]Žuran, Ivan ...Introduction: Intensive insulin treatment of critically ill patients was seen as a promising method of treatment, though recent studies showed that reducingthe blood glucose level below 6 mmol/l had ... a detrimental outcome. The mechanisms of the effects of insulin in the critically ill are not completely understood. The purpose of the study was to test the hypothesis that intensiveinsulin treatment may influence forearm blood flow independently of global hemodynamic indicators. Methods: The study encompassed 29 patients of both sexes who were admitted to the intensive care unit due to sepsis and required artificial ventilation as the result of acute respiratory failure. 14patients were randomly selected for intensive insulin treatment (Group 1; blood glucose concentration 4.4-6.1 mmol/l), and 15 were selected for conventional insulin treatment (Group 2; blood glucose level 7.0 mmol/l-11.0 mmol/l). At the start of the study (t0, beginning up to 48 hours after admittance and the commencement of artificial ventilation), at 2 hours (t1), 24 hours (t2), and 72 hours (t3) flow in the forearm was measured for 60 minutes using the strain-gauge plethysmography method. Student's t-test of independent samples was used for comparisons between the two groups, and Mann-Whitney's U-test where appropriate. Linear regression analysis and the Pearson correlation coefficient were used to determine the levels of correlation. Results: The difference in 60-minute forearm flow at the start ofthe study (t0) was not statistically significant between groups, while at t2and t3 significantly higher values were recorded in Group 1 (t2; Group 1: 420.6 +/- 188.8 ml/100 ml tissue; Group 2: 266.1 +/- 122.2 ml/100 ml tissue (95% CI 30.9-278.0, P = 0.02); t3; Group 1: 369.9 +/- 150.3 ml/100 ml tissue;Group 2: 272.6 +/- 85.7 ml/100 ml tissue (95% CI 5.4-190.0, P = 0.04). At t1 a trend towards significantly higher values in Group 1 was nVir: Critical care [Elektronski vir]. - ISSN 1466-609X (Letn. 13, št. 6, 2009, str. R198)Vrsta gradiva - e-članekLeto - 2009Jezik - angleškiCOBISS.SI-ID - 26457817
Critical Illness | Drug Therapy | Insulin | Therapeutic Use | Respiration, Artificial | Blood Glucose | Blood Flow Velocity | Forearm | Plethysmography | Apache | Randomized Controlled Trials | Krvni sladkor | Krvni pretok, hitrost | Dihanje umetno | Kritična bolezen | Inzulin | APACHE | Naključno kontrolirane, klinične preiskave | Podlaket | Pletizmografija
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