St George professor leads major clinical trial in Intensive Care
Professor John Myburgh, a senior intensive care physician at St George
Hospital, and Professor of Critical Care Medicine at the UNSW and the George
Institute for International Health, has led a major international trial into the
study of intensive care management.
Australian and New Zealand clinicians, uncertain if intensive lowering blood
glucose was harmful or beneficial to critically ill patients, have completed the
largest trial of intensive blood glucose lowering in intensive care patients,
with the findings published recently in The New England Journal of Medicine.
Prof Myburgh said that internationally, intensive blood glucose lowering has
been widely recommended and embraced to control hyperglycemia (high blood
sugar).
"This is extremely common among acutely ill patients and is linked with serious
complications such as organ failure and death.
It was found that intensively lowering blood glucose levels increased a
patient’s risk of dying by 10 per cent.
"Local researchers were concerned with this treatment strategy and decided to
conduct a large, landmark trial to confirm the best treatment for critically ill
patients," Prof Myburgh said.
"Previous, smaller research studies have produced conflicting results and
overall suggested that intensive blood glucose control did not affect death
rates in critically ill adults.
"This new study gives us more powerful information, based on this larger study
with stronger evidence," he said.
Prof Myburgh said that these new findings reveal that international practice to
intensively lower blood glucose actually increases the risk of death among
intensive care unit patients.
"It is essential that international guidelines reflect this new evidence.
"Many professional organisations recommend very tight glucose control for
Intensive Care Unit patients – they will now need to take this new evidence into
consideration and adjust recommendations accordingly," he said.
Note: The study, NICE-SUGAR (Normoglycaemia in Intensive Care Evaluation and
Survival Using Glucose Algorithm Regulation) randomly assigned patients to one
of two target ranges for blood glucose; an intensive control target (81-108mg/dL;
4.5-6.0 mmol/L) or a conventional control target (180mg/dL; 10.0 mmol/L or
less). Control of blood glucose was achieved by the use of an intravenous
infusion of insulin.
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