Archive for October, 2008|Monthly archive page

Weaning & Extubation Protocols in Neuro ICU

Rate of Re-intubation in mechanically ventilated patient neurosurgical patients : An evaluation of a systematic approach to weaning & extubation. Navalesi, P et al. Critical Care Medicine 2008 (36) 11.

This article was recently presented at QMC’s ICM journal club, who have kindly offered their presentation for inclusion on Critical Insight. You can find it in the blue box on the right, named “QMC Neuro Extubation CCM 2008”.  If your journal club would also like to submit presentations please see the “how to post” page for more info.

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Tight Glucose Control – A Meta-analysis

Benefits & Risks of Tight Glucose Control in Critically Ill Adults; A Meta-Analysis. Weiner et al. JAMA. 2008;300(8):933-944.

This meta-analysis of 28 studies of “tight glucose control” on AICU inevitably includes papers studying different protocols on different patients and hence is limited in its applicability. I’m not sure that meta-analysis serves any purpose not bettered by a brief reading of the key studies of this concept, as there is significant heterogenity within the studies and the vast majority of the numbers come from a few well known trials. The failure of any study to replicate Van de Berge’s original 30% mortality reduction now begins to suggest that the benefit of tight glucose control is at best marginal and perhaps non-existent. There is of course a potential harm from the well documented increased risk of hypoglyceamia. The meta-analysis generates an RR of 0.93 (0.85-1.03) for tight glycaemic control. They could identify no stratified group that showed a consistent mortality benefit, including medical ICU patients (as in the original study).

The accompanying editorial is more useful and summarises the problems with investigating glucose control. Namely…

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