Published ahead of print on November 30, 2006, doi:10.1164/rccm.200605-665OC Am. J. Respir. Crit. Care Med., Volume 175, Number 5, March 2007, 480-489 A more recent version of this article appeared on March 1, 2007
Submitted on May 17, 2006 Impact of Intensive Insulin Therapy on Neuromuscular Complications and Ventilator-dependency in MICUGreet Hermans1,1 Medical Intensive Care Unit, Department of Internal Medicine, University Hospitals Leuven, Katholieke Universiteit Leuven, Leuven, Belgium, 2 Department of Intensive Care Medicine, University Hospitals Leuven, Katholieke Universiteit Leuven, Leuven, Belgium, 3 Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Katholieke Universiteit Leuven, Leuven, Belgium * To whom correspondence should be addressed. E-mail: greta.vandenberghe{at}med.kuleuven.be.
Rationale: Critical illness polyneuro-and/or-myopathy causes limb and respiratory muscle weakness, prolongs mechanical ventilation and extends hospitalisation 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. Objectives: To investigate the impact of intensive insulin therapy on polyneuro-and/or-myopathy and treatment with prolonged mechanical ventilation in medical patients in the intensive care unit for at least 7 days. Methods: This was a prospectively planned sub-analysis of a randomised controlled trial evaluating the effect of intensive insulin versus conventional therapy on morbidity and mortality in critically ill medical patients. All patients who were still in intensive care on day 7 were screened weekly by electroneuromyography. The effect of intensive insulin therapy on critical illness polyneuro-and/or-myopathy and the relationship with duration of mechanical ventilation were assessed. Measurements and Main Results: Independent of risk factors, intensive insulin therapy reduced incidence of critical illness polyneuro-and/or-myopathy [107/212 (50.5%) to 81/208 (38.9%); p=0.02]. Treatment with prolonged (> 14d) mechanical ventilation was reduced from 99/212 (46.7%) to 72/208 (34.6%) (p=0.01). This was statistically only partially explained by prevention of critical illness polyneuro-and/or-myopathy. Conclusion: Also in a sub-set of medical patients in ICU for at least 7 days, enrolled in a randomised controlled trial of intensive insulin therapy, those assigned to intensive insulin therapy had a reduced incidence of critical illness polyneuro-and/or myopathy and were treated with prolonged mechanical ventilation less frequently. Key words: polyneuropathy, blood glucose, myopathy
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