Merci Erwan! La fin de Van den Berghe?!?
Il faudra lire l'article avec attention, mais il semble qu'il faudra en effet maintenant viser (comme avant l'étude de Van den Berghe) < 10 comme contrôle glycémique aux soins intensifs! Mais j,aime bien le commentaire de l'éditorial: "Notwithstanding, it would be a disservice to our critically ill patients to infer from the NICE-SUGAR data that neglectful glycemic control involving haphazard therapeutic approaches (e.g., use of insulin "sliding scales") — all too common a decade ago — is again acceptable practice in our ICUs." Patrick 2009/3/25 <[email protected]> > > Publié hier !!! > > *Intensive versus Conventional Glucose Control in Critically Ill Patients* > > *The NICE-SUGAR Study Investigators * > > *ABSTRACT* > > *Background* The optimal target range for blood glucose in critically ill > patients remains unclear. > > *Methods* Within 24 hours after admission to an intensive care unit (ICU), > adults who were expected to require treatment in the ICU on 3 or more > consecutive days were randomly assigned to undergo either intensive > glucose control, with a target blood glucose range of 81 to 108 mg per > deciliter (4.5 to 6.0 mmol per liter), or conventional glucose control, > with a target of 180 mg or less per deciliter (10.0 mmol or less per > liter). We defined the primary end point as death from any cause within 90 > days after randomization. > > *Results* Of the 6104 patients who underwent randomization, 3054 were > assigned to undergo intensive control and 3050 to undergo conventional > control; data with regard to the primary outcome at day 90 were available > for 3010 and 3012 patients, respectively. The two groups had similar > characteristics at baseline. A total of 829 patients (27.5%) in the > intensive-control group and 751 (24.9%) in the conventional-control group > died (odds ratio for intensive control, 1.14; 95% confidence interval, > 1.02 to 1.28; P=0.02). The treatment effect did not differ significantly > between operative (surgical) patients and nonoperative (medical) patients > (odds > ratio for death in the intensive-control group, 1.31 and 1.07, > respectively; P=0.10). Severe hypoglycemia (blood glucose level, 40 mg per > deciliter [2.2 mmol per liter]) was reported in 206 of 3016 patients > (6.8%) in the intensive-control group and 15 of 3014 (0.5%) in the > conventional-control group (P<0.001). There was no significant difference > between the two treatment groups in the median number of days in the ICU > (P=0.84) or hospital (P=0.86) or the median number of days of mechanical > ventilation (P=0.56) or renal-replacement therapy (P=0.39). > > *Conclusions* In this large, international, randomized trial, we found > that intensive glucose control increased mortality among adults in the > ICU: a blood glucose target of 180 mg or less per deciliter resulted in > lower mortality than did a target of 81 to 108 mg per deciliter. > (ClinicalTrials.gov number, NCT00220987 > *[ClinicalTrials.gov]*<http://cgi/external_ref?access_num=NCT00220987&link_type=CLINTRIALGOV>.) > > Dr Erwan L'Her, MD, PhD > Intensiviste et Urgentologue > Professeur au Dép. Médecine Familiale et Médecine d'Urgence > et titulaire de la Chaire de recherche en médecine d'urgence > Université Laval/CHAU Hôtel-Dieu de Lévis > > > > *patrick archambault <[email protected]>* > > 2009-03-25 13:15 Veuillez répondre à > [email protected] > > A > [email protected] cc > Objet > URG-L: FW: InfoPOEM: Intensive glucose control ineffective inICU patients > > > > > > > Les résultats de l'étude NICE-Sugar seront très intéressants à avoir > lorsque publiés: * > http://www.ncbi.nlm.nih.gov/pubmed/19281445?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum > *<http://www.ncbi.nlm.nih.gov/pubmed/19281445?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum> > > Patrick Archambault > > 2009/3/25 M. Chenier <*[email protected]* <[email protected]>> > C'est pas la seule dans le domaine du contrôle intensif de la glycémie: > * > **http://www.ncbi.nlm.nih.gov/pubmed/18539917?dopt=Abstract*<http://www.ncbi.nlm.nih.gov/pubmed/18539917?dopt=Abstract> > * > **http://www.ncbi.nlm.nih.gov/pubmed/18728267?dopt=Abstract*<http://www.ncbi.nlm.nih.gov/pubmed/18728267?dopt=Abstract> > > *M. Chénier* > > *[email protected]* <[email protected]> > > > > Alain Vadeboncoeur wrote: > Fascinant quand même de nombre d'études qui se publient sur L'ABSENCE de > gains dans divers contextes d'un contrôle serré de la glycémie! > > Alain > > ------------------------------ > *From:* *[email protected]* <[email protected]> [* > mailto:[email protected]* <[email protected]>] *On Behalf Of *Équipe > éditoriale de *amc.ca* <http://amc.ca/>* > Sent:* 25 mars 2009 04:00* > To:* *[email protected]* <[email protected]>* > Subject:* InfoPOEM: Intensive glucose control ineffective in ICU patients > Pour assurer la livraison de ce courriel dans votre boîte de réception, > veuillez ajouter *[email protected]* <[email protected]> à votre carnet de > contacts. > > *Intensive glucose control ineffective in ICU patients* > > *Clinical question * > Does tight control of blood glucose improve survival of patients in a > medical surgical intensive care unit? > > *Bottom line * > Tight control of blood glucose levels -- 80 mg/dL to 110 mg/dL (4.4-6.1 > mmol/L) -- did not decrease mortality or other measured outcomes in patients > admitted to an intensive care unit (ICU) with hyperglycemia. Hypoglycemia > was much more common and was associated with an increased mortality. A > meta-analysis has found similar results. *(LOE = > 1b)*<http://mailer.cma.ca/t/4155251/234493/102001/0/> > > *Reference ** > **Arabi YM, Dabbagh OC, Tamim HM, et al. Intensive versus conventional > insulin therapy: A randomized controlled trial in medical and surgical > critically ill patients. Crit Care Med > 2008;36(12):3190-3197.*<http://mailer.cma.ca/t/4155251/234493/4597965/0/> > > *Study design* > Randomized controlled trial (nonblinded) > > *Funding* > Foundation > > *Allocation* > Concealed > > *Setting* > Inpatient (ICU only) > > > * **Obtenez des crédits > Mainpro* <http://mailer.cma.ca/t/4155251/234493/4598439/0/> * **Discutez > de cet > InfoPOEM* <http://mailer.cma.ca/t/4155251/234493/4597967/0/> * ** > Archives* <http://mailer.cma.ca/t/4155251/234493/145011/0/> * **Bilan des > crédits* <http://mailer.cma.ca/t/4155251/234493/177011/0/> * **Plus de > FMC / DPC* <http://mailer.cma.ca/t/4155251/234493/3021/0/> > > <http://mailer.cma.ca/t/4155251/234493/196001/0/> > Publicité > > > * **Bibliothécaire de > l'AMC*<http://mailer.cma.ca/t/4155251/234493/147004/0/> > > > * **Envoyez-nous vos commentaires* <[email protected]> > > > *Synopsis * > The Saudi Arabian investigators conducting this study enrolled 523 adults > in a medical surgical ICU. The unit was closed and covered at all times by > an intensivist. The patients (75% men) did not have type 1 diabetes, though > 40% had a history of type 2 diabetes. The average blood glucose level was > 194 mg/dL (10.8 mmol/L) in the intensive insulin group and 210 mg/dL (11.7 > mmol/L) in the conventional insulin group. Most of the patients were > nonoperative and were critically ill; 85% were mechanically ventilated and > 65% were receiving vasopressors, with a mortality rate was approximately > 15%. All patients received an infusion of regular insulin and were randomly > assigned, using concealed allocation, to have their blood glucose maintained > at 80 mg/dL to 110 mg/dL (4.4 - 6.1 mmol/L) in the intensive insulin group > and 180 mg/dL to 200 mg/dL (10.0-11.1 mmol/L) in the conventional treatment > group. Analysis was by intention to treat. The main outcome, in-ICU > mortality, was not different between the 2 groups. At least one episode of > hypoglycemia occurred in 28.6% of patients in the tight control group and > 3.1% of patients in the conventional treatment group. In-ICU mortality was > higher among those who had hypoglycemia (23.8% vs 13.7%; P = .02). There was > no difference in in-hospital mortality, ICU or hospital length of stay, > ventilation duration, infections, or the need for transfusion. These results > are similar to those found in a previous meta-analysis (JAMA > 2008;300(8):933-944). > > *Discutez de cet InfoPOEM*<http://mailer.cma.ca/t/4155251/234493/4597967/0/> > > *Archives* > > *InfoPOEMs (contenu > anglais)*<http://mailer.cma.ca/t/4155251/234493/145011/0/>| > *CLIPs (contenu anglais)*<http://mailer.cma.ca/t/4155251/234493/322001/0/>| > *Critique et pratique* <http://mailer.cma.ca/t/4155251/234493/177003/0/> > > *Ressources cliniques* > > *Accueil* <http://mailer.cma.ca/t/4155251/234493/94016/0/> | *Manuels > **<http://mailer.cma.ca/t/4155251/234493/177004/0/>| > *Revues ** <http://mailer.cma.ca/t/4155251/234493/177005/0/> | *Information > médicaments ** <http://mailer.cma.ca/t/4155251/234493/145012/0/> | *Tests > de laboratoire ** <http://mailer.cma.ca/t/4155251/234493/128015/0/> | * > InfoPOEMs* <http://mailer.cma.ca/t/4155251/234493/145011/0/> | *Guide de > pratique clinique* <http://mailer.cma.ca/t/4155251/234493/324016/0/> | > * > **Documents d'information pour les patients > **<http://mailer.cma.ca/t/4155251/234493/177007/0/>| > *Bibliothécaire de l'AMC **<http://mailer.cma.ca/t/4155251/234493/147004/0/> > > *Raccourcis* > > *MD Consult ** <http://mailer.cma.ca/t/4155251/234493/145015/0/> | *STAT!Ref > ** <http://mailer.cma.ca/t/4155251/234493/148015/0/> | *[email protected] > **<http://mailer.cma.ca/t/4155251/234493/177008/0/>| > *OVID Medline ** <http://mailer.cma.ca/t/4155251/234493/145016/0/> | *Revues > EBSCO ** <http://mailer.cma.ca/t/4155251/234493/145014/0/> | > *JAMC*<http://mailer.cma.ca/t/4155251/234493/177009/0/>| > *Essential Evidence Plus *<http://mailer.cma.ca/t/4155251/234493/138018/0/>| > *MedCalc 3000 ** <http://mailer.cma.ca/t/4155251/234493/177010/0/> > > *FMC / DPC* > > *Voir les cours en ligne* <http://mailer.cma.ca/t/4155251/234493/3021/0/>| > *Bilan des crédits* <http://mailer.cma.ca/t/4155251/234493/177011/0/> > > *Gestion de la pratique* > > *Accueil* <http://mailer.cma.ca/t/4155251/234493/77020/0/> | *Créez un > site Web de pratique* <http://mailer.cma.ca/t/4155251/234493/140/0/> | > *Clinique > informatisée* <http://mailer.cma.ca/t/4155251/234493/234014/0/> | > *Bureau*<http://mailer.cma.ca/t/4155251/234493/234015/0/>| > *Dotation en personnel* <http://mailer.cma.ca/t/4155251/234493/234016/0/>| > *Finances* <http://mailer.cma.ca/t/4155251/234493/234017/0/> | *Juridique > et vie privée* <http://mailer.cma.ca/t/4155251/234493/234018/0/> > > * Service aux membres AMC > > > > POEMs veut dire "Patient-Oriented Evidence that Matters". > > Désirez-vous changer le format de vos courriels d'InfoPOEMs quotidiens ou > votre adresse courriel de la liste d'InfoPOEMs quotidiens? * > **Gérez vos options d'InfoPOEMs > quotidiens*<http://mailer.cma.ca/t/4155251/234493/3026/0/>à partir du site Web > *amc.ca* <http://amc.ca/>. > Cliquez ici pour vous > *désabonner*<http://mailer.cma.ca/u?id=234493.2ee32010d4b1d8089bbf2b767ebd5713&o=4155251&u=http://www.cma.ca/index.cfm/ci_id/324/la_id/2.htm&w=F&a=T&c=F&l=poem>. > > > Copyright © 1995-2009 InfoPOEM, Inc. > *www.infopoems.com*<http://mailer.cma.ca/t/4155251/234493/3966545/0/>. > Tous droits réservés. > Copyright © 2009 Association Médicale Canadienne, Tous droits réservés. > > > > > >
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