INTENSIVE INSULIN THERAPY IS AN APPROPRIATE THERAPEUTIC STRATEGY FOR NON-DIABETIC HYPERGLYCEMIC POST-SURGICAL PATIENTS ADMITTED TO ICU
Mohammed F. Abosamak
Department of Anesthesia & ICU, Faculty of Medicine, Tanta University
Objectives: To determine postoperative (PO) morbidities and mortalities of non-diabetic surgical patients required ICU admission and developed postoperative stress hyperglycemia (PSH) that was managed by intravenous insulin therapy (IV-IT). Patients & Methods: 172 PO patients admitted to surgical ICU and developed PSH were randomly allocated, according to strategy of IV-IT, into IV-CIT or IV-IIT. IV-CIT was provided as a continuous infusion of 50 IU of Actrapid HM in 50 ml of 0.9% sodium chloride using a pump to achieve blood glucose (BG) level in range of 180-200 mg/dl. IV-IIT was provided at rate of 1 mU/kg/min to achieve BG level in range of 80-110 mg/dl. In both groups, on achievement of the targeted BG level, 6-hourly subcutaneous insulin therapy (sc-IT) was started, BG was estimated daily and IV-IT was resumed if indicated. Study outcomes include the number of IV-IT sessions required till stabilization of the targeted BG level, frequencies of relapses of hyperglycemia, and the 28-day morbidity and mortality rates. Results: Number of IV-IT sessions was significantly lower with IV-IIT with significantly higher frequency of patients who had achieved normoglycemia on days 1-3 of follow-up. Moreover, mean of estimated levels of BG was significantly lower among patients received IIT throughout four days of follow-up. The 28-day ICU morbidity and mortality rates were 19.8% and 9.3%, respectively showed negative correlation with the use of IIT, but showed a positive significant correlation with PSH severity and resistance to IT as manifested by multiplicity of IV-IT sessions that was defined by statistical analyses as the significant predictor for high morbidity and mortality rates. Conclusion: PSH in non-diabetic surgical patients is not infrequent event that required intensive management. Despite of IV-IT, morbidity and mortality rates were 19.8% & 9.3%, respectively. IV-IIT allowed reductions of number of IV-IT sessions and duration to achieve the target BG. The need for multiple IV-IT sessions can predict worse outcome.