This is the podcast, Surgery, ICRounds. My name is Dr. Jeffrey Guy. I'm an associate professor of surgery and director of the Burn Center of Vandabert Regional Burn Center at the Vanderbilt University School of Medicine in Nashville, Tennessee. The topic that I want to talk to you about today is the topic of tight glucose control and critically ill patients. There was a meta-analysis that appeared recently in the Journal of the American Medical Association.

It appeared in August 26, 2008, and it was an interesting meta-analysis, in my opinion,

that looked at what has turned into a reasonably controversial topic as to where do we draw the line for adequate control of blood

glucose in the critically ill patients. The article is entitled Benefits and Risk of Tight

Glucose Control and Critically Al Patients of Metanalysis, and it's by Weiner and colleagues,

and as I said, it's appeared in the August 26th edition of the journal.

We're certainly all aware, or certainly should be aware, that in 2001,

Vanderberg and colleagues published a randomized control trial of critically ill surgical patients,

showing that tight glucose control and hospitalized critically ill patients reduce hospital mortality by a third.

But since that period of time, there's been a tremendous amount of research in that area.

Most of the studies are not nearly as good as the Vanderberg trial, looking at the benefit

of a tight glycemic control in the critical ill patients.

In the Vanderberg study, the greatest decrease in death occurred to the subgroup of patients with sepsis and multisystem or organ fire.

Some speculated the benefits of tight glucose control might extend to medical intensive care

of you in patients as well.

Well, certainly saying that you're able to reduce mortality by that magnitude certainly creates a lot of excitement and subsequent investigation.

The article goes on to say that because few interventions in critical ill adults reduce mortality

to the extent reported by Vandenberg, the results of that trial enthusiastically received and rapidly

incorporated the guidelines. In the 2004 surviving

substance guidelines, they recommended control for all patients with sepsis, and in the 2004

guidelines they explicitly stated in quoting here, there is no reason to think that these

data are not generalizable to all severely septic patients. What is interesting is that looking at the guidelines that are forthcoming from groups like

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