Intensive insulin therapy in severely burned pediatric patients: A prospective randomized trial
American Journal of Respiratory and Critical Care Medicine
Year, Volume, Issue, Page(s):
2010, vol. 182, issue 3, pp 351-359
Study explored whether intensive insulin therapy is associated with improved post-burn morbidity and mortality. A total of 239 severely burned children with burns over more than 30 percent of their total body surface area were randomized to intensive insulin treatment or control. Demographics, clinical outcomes, sepsis, glucose metabolism, organ function, and inflammatory, acute phase, and hypermetabolic responses were determined. Demographics were similar in both groups. Control patients were targeted to maintain glucose levels 140 to 180 milligrams per deciliter (mg/dl), whereas intensive insulin-treated patients received insulin to maintain glucose levels between 80 and 110 mg/dl. Intensive insulin treatment significantly decreased the incidence of infections and sepsis compared with controls. Furthermore, intensive insulin therapy improved organ function as indicated by improved serum markers, DENVER2 scores, and ultrasound. Intensive insulin therapy alleviated post-burn insulin resistance and the vast catabolic response of the body. Intensive insulin treatment dampened inflammatory and acute-phase responses compared with controls. Mortality was 4 percent in the intensive insulin therapy group and 11 percent in the control group.
Jeschke MG, Kulp GA, Kraft R, Finnerty CC, Mlcak R, Lee JO, Herndon DN
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