Insulintherapie in der Intensivmedizin – Frage nach dem optimalen Blutzucker–Zielbereich bei schwer kranken Patienten

Abstract

Ever since publication of the spectacular study data of van den Berghe et al. in 2001 on the effect exercised by insulin therapy in the intensive-care ward, the subject of blood sugar control in severely diseased patients has been under heavy cross-fire. At that time a stringently exercised insulin therapy in mainly cardiosurgical patients resulted in a significant reduction of the mortality risk. Therapy algorithms were subsequently modified by numerous intensive-care units and strategies mapped out to utilize the evidence of this initial study. A subsequent publication by the same group already showed in medical intensive-care patients less pronounced advantages offered by a near-normoglycemic metabolism. A large-scale study in patients suffering from sepsis was even discontinued because of increased hypoglycemias under intensive glucose control. Finally, the largest ever study of this problem comprising more than 6 000 intensive-care patients was published under the designation NICE-SUGAR. In this study the 90-day mortality risk was higher with intensive metabolic adjustment than with the control group. Hence, the problem of the most favorable blood sugar target range in intensive-care units remains unsolved. A summing-up of the various items of evidence in a practically useful guideline would be of help to intensive-care units.