Early versus late intravenous insulin administration in critically ill patients

Shyoko Honiden, Atara Schultz, Shelly A. Im, David M. Nierman, Michelle Ng Gong

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Objective: To investigate whether timing of intensive insulin therapy (IIT) after intensive care unit (ICU) admission influences outcome. Design and setting: Single-center prospective cohort study in the 14-bed medical ICU of a 1,171-bed tertiary teaching hospital. Patients: The study included 127 patients started on ITT within 48 h of ICU admission (early group) and 51 started on ITT thereafter (late group); the groups did not differ in age, gender, race, BMI, APACHE III, ICU steroid use, admission diagnosis, or underlying comorbidities. Measurements and results: The early group had more ventilator-free days in the first 28 days after ICU admission (median 12 days, IQR 0-24, vs. 1 day, 0-11), shorter ICU stay (6 days, IQR 3-11, vs. 11 days, vs. 7-17), shorter hospital stay (15 days, IQR 9-30, vs. 25 days, 13-43), lower ICU mortality (OR 0.48), and lower hospital mortality (OR 0.27). On multivariate analysis, early therapy was still associated with decreased hospital mortality (ORadj 0.29). The strength and direction of association favoring early IIT was consistent after propensity score modeling regardless of method used for analysis. Conclusions: Early IIT was associated with better outcomes. Our results raise questions about the assumption that delayed administration of IIT has the same benefit as early therapy. A randomized study is needed to determine the optimal timing of therapy.

Original languageEnglish (US)
Pages (from-to)881-887
Number of pages7
JournalIntensive Care Medicine
Volume34
Issue number5
DOIs
StatePublished - May 2008
Externally publishedYes

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Critical Illness
Intravenous Administration
Intensive Care Units
Insulin
Secondary Prevention
Hospital Mortality
Therapeutics
Propensity Score
APACHE
Mechanical Ventilators
Tertiary Care Centers
Teaching Hospitals
Comorbidity
Length of Stay
Cohort Studies
Multivariate Analysis
Steroids
Prospective Studies
Mortality

Keywords

  • Critical illness
  • Hyperglycemia
  • Insulin
  • Mortality

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Early versus late intravenous insulin administration in critically ill patients. / Honiden, Shyoko; Schultz, Atara; Im, Shelly A.; Nierman, David M.; Gong, Michelle Ng.

In: Intensive Care Medicine, Vol. 34, No. 5, 05.2008, p. 881-887.

Research output: Contribution to journalArticle

Honiden, Shyoko ; Schultz, Atara ; Im, Shelly A. ; Nierman, David M. ; Gong, Michelle Ng. / Early versus late intravenous insulin administration in critically ill patients. In: Intensive Care Medicine. 2008 ; Vol. 34, No. 5. pp. 881-887.
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