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Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Increased blood flow by insulin infusion targeting normoglycemia in patients with severe sepsis: friend or foe? | Van den Berghe Critical Care 2010 14 122 http ccforum.eom content 14 1 122 CRITICAL CARE COMMENTARY L__ Increased blood flow by insulin infusion targeting normoglycemia in patients with severe sepsis friend or foe Greet Van den Berghe See related research by Zuran etal. http ccforum.eom content 13 6 R198 Abstract A small study in patients with severe sepsis suggested that insulin infused to normalize blood glucose levels increased forearm flow. This clinical observation supports the effect of insulin on the endothelium as previously shown by in vitro studies and by in vivo animal models of critical illness but the clinical consequences remain unclear. In the previous issue of Critical Care Dr Zuran and collaborators reported the results of an interesting smallsized open-label study investigating the effects of targeting different levels of blood glucose with insulin in patients with severe sepsis 1 . As compared with a blood glucose target of 7 to 11 mmol l targeting a blood glucose level of 4.4 to 6.1 mmol l increased forearm blood flow measured by the strain-gauge plethysmography method at 24 and 72 hours after initiation of the intervention. These differences occurred in the absence of detectable differences in hemodynamics or patient outcome. The authors concluded that these data corroborate a protective effect on the endothelium and attribute this to the amount of insulin rather than to the level of blood glucose control. Zuran and colleagues study is an interesting clinical observation made in a difficult setting of clinical practice treating patients with sepsis and organ failure for which the authors ought to be congratulated. The small sample size with a trend for slightly different baseline characteristics particularly concerning the severity of the shock as well as the nonblinded nature of the study Correspondence greet.vandenberghe@med.kuleuven.be Department of Intensive Care Medicine Catholic University of Leuven B-3000 Leuven Belgium 2 BioMed
