Intensivmedizin Fragen und Antworten

13 · Klinische Studien
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Results Survival in group 1 was significantly lower than in groups 2 (p=0.0007)
and 3 (p=0.0013). Survival in groups 2 and 3 did not differ significantly
(p=0.87). Adjustment for possible confounding factors did not change the pattern
of differences among the groups. Survivors in all groups had lower concentrations
of blood urea nitrogen before continuous haemofiltration was
started than non-survivors. 95 %, 92 %, and 90 % of survivors in groups 1, 2,
and 3, respectively, had full recovery of renal function. The frequency of complications
was similarly low in all groups.
Interpretation Mortality among these critically ill patients was high, but increase
in the rate of ultrafiltration improved survival significantly. We recommend
that ultrafiltration should be prescribed according to patient’s bodyweight
and should reach at least 35 ml h -1 kg -1 .
Fazit
Bei generell hoher Sterblichkeit in diesem Patientengut führte die Erhöhung des
Filtrationsvolumens zu einer Verbesserung der Überlebensquote. Die Autoren
empfehlen ein Filtrationsvolumen von mindestens 35 ml/h/kg.
jIntensivierte Insulintherapie bei Intensivpatienten
(n=1548 Patienten, prospektive und randomisierte Studie)
Van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Vlasselaers
D, Ferdinande P, Lauwers P, Bouillon R (2001) Intensive insulin therapy in critically ill
patients. N Engl J Med 345: 1359–1367
Background Hyperglycemia and insulin resistance are common in critically
ill patients, even if they have not previously had diabetes. Whether the normalization
of blood glucose levels with insulin therapy improves the prognosis for
such patients is not known.
Methods We performed a prospective, randomized, controlled study involving
adults admitted to our surgical intensive care unit who were receiving
mechanical ventilation. On admission, patients were randomly assigned to
receive intensive insulin therapy (maintenance of blood glucose at a level between
80 and 110 mg per deciliter [4.4 and 6.1 mmol per liter]) or conventional
treatment (infusion of insulin only if the blood glucose level exceeded 215 mg
per deciliter [11.9 mmol per liter] and maintenance of glucose at a level between
180 and 200 mg per deciliter [10.0 and 11.1 mmol per liter]).
Results At 12 months, with a total of 1548 patients enrolled, intensive insulin
therapy reduced mortality during intensive care from 8.0 percent with conven-