Tight glycemic control protects the myocardium and reduces inflammation in neonatal heart surgery.

Background: Neonatal cardiac surgery evokes hyperglycemia and a systemic inflammatory response. Hyperglycemia is associated with intensified inflammation and adverse outcome in critically ill children and in pediatric cardiac surgery. Recently we demonstrated that tight glycemic control (TGC) reduced morbidity and mortality of critically ill children.

Blood glucose measurements in arterial blood of intensive care unit patients submitted to tight glycemic control: agreement between bedside tests.

Background: Implementing tight glycemic control (TGC) in intensive care unit (ICU) patients requires accurate blood glucose (BG) monitoring. We evaluated the performance of two commercially available bedside glucometers, Accu-Chek and HemoCue, in patients admitted to the ICU and in whom TGC was applied.

Methods: Thirty-seven adult ICU patients were prospectively included.

The effect of strict blood glucose control on biliary sludge and cholestasis in critically ill patients.

Background And Aims: Cholestatic liver dysfunction and biliary sludge are common problems in critically ill patients. No specific strategies have been described to prevent cholestasis and biliary sludge in the intensive care unit (ICU). We examined liver dysfunction and biliary sludge prospectively in a large medical long-stay ICU population and hypothesized that tight glycemic control with intensive insulin therapy (IIT) reduces cholestasis and biliary sludge.

Intensive insulin therapy for patients in paediatric intensive care: a prospective, randomised controlled study.

Background: Critically ill infants and children often develop hyperglycaemia, which is associated with adverse outcome; however, whether lowering blood glucose concentrations to age-adjusted normal fasting values improves outcome is unknown. We investigated the effect of targeting age-adjusted normoglycaemia with insulin infusion in critically ill infants and children on outcome.

Methods: In a prospective, randomised controlled study, we enrolled 700 critically ill patients, 317 infants (aged <1 year) and 383 children (aged >or=1 year), who were admitted to the paediatric intensive care unit (PICU) of the University Hospital of Leuven, Belgium.

Serial lactate measurements using microdialysis of interstitial fluid do not correlate with plasma lactate in children after cardiac surgery.

Objectives: Serial postoperative blood lactate (BL) concentrations have been shown to predict outcome of children after congenital heart surgery (CHS), and interventions aimed at lowering lactate can improve the outcome of these children. The cumulative blood loss for diagnostic purposes, such as repetitive arterial blood sampling in the intensive care unit, contributes, especially in small children, to anemia. Techniques to limit blood loss can therefore be of use.

Polymorphisms in innate immunity genes predispose to bacteremia and death in the medical intensive care unit.

Objective: Critically ill patients are at risk of sepsis, organ failure, and death. Studying the impact of genetic determinants may improve our understanding of the pathophysiology and allow identification of patients who would benefit from specific treatments. Our aim was to study the influence of single nucleotide polymorphisms in selected genes involved in innate immunity on the development of bacteremia or risk of death in patients admitted to a medical intensive care unit.

Effect of insulin therapy on coagulation and fibrinolysis in medical intensive care patients.

Objective: Most intensive care deaths beyond the first few days of critical illness are attributable to nonresolving organ failure, either due to or coinciding with sepsis. One of the mechanisms that is thought to contribute to the pathogenesis of organ failure is microvascular thrombosis. Recently, we reported significant improved survival and prevention of organ failure with the use of intensive insulin therapy to maintain normoglycemia for at least several days.

Impact of intensive insulin therapy on neuromuscular complications and ventilator dependency in the medical intensive care unit.

Rationale: Critical illness polyneuropathy/myopathy causes limb and respiratory muscle weakness, prolongs mechanical ventilation, and extends hospitalization of intensive care patients. Besides controlling risk factors, no specific prevention or treatment exists. Recently, intensive insulin therapy prevented critical illness polyneuropathy in a surgical intensive care unit.

Intensive insulin therapy in mixed medical/surgical intensive care units: benefit versus harm.

Intensive insulin therapy (IIT) improves the outcome of prolonged critically ill patients, but concerns remain regarding potential harm and the optimal blood glucose level. These questions were addressed using the pooled dataset of two randomized controlled trials. Independent of parenteral glucose load, IIT reduced mortality from 23.

Strict blood glucose control with insulin during intensive care after cardiac surgery: impact on 4-years survival, dependency on medical care, and quality-of-life.

Aims: To document the impact of intensive insulin therapy during intensive care on long-term (4 years) outcome of high-risk cardiac surgery patients.

Methods And Results: In this pre-planned sub-analysis and follow-up study of a large, randomized controlled trial on the effects of intensive insulin therapy during critical illness, we assessed long-term outcome in the 970 patients who had been admitted after high-risk cardiac surgery (mean+/-SD EuroSCORE of 6.0+/-3.

Intensive insulin therapy in the medical ICU.

Background: Intensive insulin therapy reduces morbidity and mortality in patients in surgical intensive care units (ICUs), but its role in patients in medical ICUs is unknown.

Methods: In a prospective, randomized, controlled study of adult patients admitted to our medical ICU, we studied patients who were considered to need intensive care for at least three days. On admission, patients were randomly assigned to strict normalization of blood glucose levels (80 to 110 mg per deciliter [4.