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Benefits of intensive insulin therapy on neuromuscular complications in routine daily critical care practice: a retrospective study

Greet Hermans1†, Maarten Schrooten2†, Philip Van Damme2,3, Noor Berends4, Bernard Bouckaert4, Wouter De Vooght2, Wim Robberecht2,3 and Greet V Berghe4*

Author Affiliations

1 Medical Intensive Care Unit, Department of Internal Medicine, University Hospitals Leuven, Catholic University Leuven, Herestraat 49, B-3000 Leuven, Belgium

2 Department of Neurology, University Hospitals Leuven, Catholic University Leuven, Herestraat 49, B-3000 Leuven, Belgium

3 Laboratory for Neurobiology, Department of Experimental Neurology, Flemish Institute for Biotechnology, Catholic University Leuven, Herestraat 49, B-3000 Leuven, Belgium

4 Department of Intensive Care Medicine, University Hospitals Leuven, Catholic University Leuven, Herestraat 49, B-3000 Leuven, Belgium

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Critical Care 2009, 13:R5 doi:10.1186/cc7694


See related commentary by Callahan and Supinski, http://ccforum.com/content/13/2/125

Published: 24 January 2009

Abstract

Introduction

Intensive insulin therapy (IIT) reduced the incidence of critical illness polyneuropathy and/or myopathy (CIP/CIM) and the need for prolonged mechanical ventilation (MV ≥ 14 days) in two randomised controlled trials (RCTs) on the effect of IIT in a surgical intensive care unit (SICU) and medical intensive care unit (MICU). In the present study, we investigated whether these effects are also present in daily clinical practice when IIT is implemented outside of a study protocol.

Methods

We retrospectively studied electrophysiological data from patients in the SICU and MICU, performed because of clinical weakness and/or weaning failure, before and after routine implementation of IIT. CIP/CIM was diagnosed by abundant spontaneous electrical activity on electromyography. Baseline and outcome variables were compared using Student's t-test, Chi-squared or Mann-Whitney U-test when appropriate. The effect of implementing IIT on CIP/CIM and prolonged MV was assessed using univariate analysis and multivariate logistic regression analysis (MVLR), correcting for baseline and ICU risk factors.

Results

IIT significantly lowered mean (± standard deviation) blood glucose levels (from 144 ± 20 to 107 ± 10 mg/dl, p < 0.0001) and significantly reduced the diagnosis of CIP/CIM in the screened long-stay patients (125/168 (74.4%) to 220/452 (48.7%), p < 0.0001). MVLR identified implementing IIT as an independent protective factor (p < 0.0001, odds ratio (OR): 0.25 (95% confidence interval (CI): 0.14 to 0.43)). MVLR confirmed the independent protective effect of IIT on prolonged MV (p = 0.002, OR:0.40 (95% CI: 0.22–0.72)). This effect was statistically only partially explained by the reduction in CIP/CIM.

Conclusions

Implementing IIT in routine daily practice in critically ill patients evoked a similar beneficial effect on neuromuscular function as that observed in two RCTs. IIT significantly improved glycaemic control and significantly and independently reduced the electrophysiological incidence of CIP/CIM. This reduction partially explained the beneficial effect of IIT on prolonged MV.