URG-L: Re : URG-L: FW: InfoPOEM: Strict blood sugar control increases ICUmortality (NICE-SUGAR)

cbich Fri, 08 May 2009 09:40:46 -0700

Effectivement.Assez étonnant compte tenu de la récente emphase mise là-dessus,du genre thérapie avec insuline IV même pour les patients non diabétiques.

C.

----- Message d'origine -----
De: Alain Vadeboncoeur <[email protected]>
Date: Vendredi, 8 Mai 2009, 8:19
Objet: URG-L: FW: InfoPOEM: Strict blood sugar control increases ICU mortality (NICE-SUGAR)
À: [email protected]

> Bon ben oublions le controle agressif du glucose...

> Alain

> From: [email protected] [mailto:[email protected]] On Behalf Of Équipe éditoriale de amc.ca
> Sent: 8 mai 2009 04:00
> To: [email protected]
> Subject: InfoPOEM: Strict blood sugar control increases ICU mortality (NICE-SUGAR)

> Pour assurer la livraison de ce courriel dans votre boîte de réception, veuillez ajouter [email protected] à votre carnet de contacts.

> Strict blood sugar control increases ICU mortality (NICE-SUGAR)

Clinical question
> Does strict blood sugar control improve clinical outcomes in patients admitted to the intensive care unit?

Bottom line
> This study should provide the final nail in the coffin for the seductive but ultimately incorrect idea that tight control improves outcomes in intensive care unit (ICU) patients. In this large, well-designed study, a target of 80 mg/dL to 108 mg/dL (4.5 - 6.0 mmol) actually increased mortality compared with a target of less than or equal to 180 mg/dL (<= 10 mmol/L), with a number needed to treat to harm of 38. (LOE = 1b)

Reference
> The NICE-SUGAR Study Investigators; Finfer S, Chittock DR, Su SY, et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med 2009;360(13):1283-1297.

Study design
> Randomized controlled trial (nonblinded)

Funding
> Government

Allocation
> Concealed

Setting
> Inpatient (ICU only)

	> Obtenez des crédits > Mainpro
	> Discutez de cet > InfoPOEM
	> Archives
	> Bilan des crédits
	> Plus de FMC / DPC

> Publicité

> Bibliothécaire de l'AMC

> Envoyez-nous vos commentaires

> Synopsis
> A previous study of 524 patients (Crit Care Med 2008;36(12):3190-3197; POEM #110351) and a previous meta-analysis (JAMA 2008;300(8):933-944; POEM #101024) failed to show any benefit of tight glucose control for patients admitted to the ICU. In this large multicenter study, patients expected to require at least 3 days of ICU treatment were randomly assigned to tight control with a blood sugar target of 81 mg/dL to 108 mg/dL (4.5 - 6.0 mmol/L) or usual care with a target of 180 mg/dL or less (10 mmol or less). Analysis was by intention to treat, and groups were balanced at the start of the study. The mean age of the 6104 participants was 60 years, 36% were women, and 37% were admitted for an operative reason. The assigned treatment was discontinued prematurely in 10% of patients in the intensive therapy group and 7.4% in the usual care group; the most common reason was a change to palliative care as the goal of treatment. At 90 days, mortality was higher in the intensive control group (27.5% vs 24.9%; P = .02; number needed to treat to harm = 38). There was no difference between groups in length of stay in the ICU. Cardiovascular deaths were more common in the intensive control group.

Discutez de cet InfoPOEM

> Archives

InfoPOEMs (contenu anglais) | CLIPs (contenu anglais) | Critique et pratique

Ressources cliniques

Raccourcis

FMC / DPC

Voir les cours en ligne | Bilan des crédits

Gestion de la pratique

* 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 à partir du site Web amc.ca.
> Cliquez ici pour vous désabonner.

URG-L: Re : URG-L: FW: InfoPOEM: Strict blood sugar control increases ICUmortality (NICE-SUGAR)

Répondre à