Endocrine Critical Care

Intensive insulin therapy
van Den Berghe, Wouters P, Weekers F, et al. Intensive insulin therapy in the critically ill patients. N Engl J Med 2001;345:1359-1377.  Landmark RCT found patients in a surgical intensive care unit receiving intensive insulin therapy (blood glucose 80-110 mg/dl) had improved ICU mortality (4.6% vs. 8% in conventional group).  Although the study was performed in an SICU population, patients in the ICU > 5 days and patients with multi-organ failure related to sepsis showed the greatest benefit, which suggested the results were applicable to the MICU. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11794168

van den Berghe G, Wilmer A, Hermans G, et al. Intensive insulin therapy in the medical ICU. N Engl J Med. 2006; 354:449-61. RCT of 1200 MICU patients found those randomized to intense therapy had reduced risk of acute renal injury and shorter duration of ICU stay, but no difference in mortality. Of note, patients with ICU stays < 3 days had higher mortality than controls while those with stays > 3 days had reduced mortality with intensive control. http://www.ncbi.nlm.nih.gov/pubmed/16452557?ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus

Brunkhorst FM, Engel C, Bloos F, et al. Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med  2008;358:125-139. This multicenter 2-by-2 factorial trial of 537 patients was stopped early due to elevated rates of severe hypoglycemia in the intensive control arm (17.0% vs. 4.1% in non-intensive arm, p < .001). No differences in 28-day mortality were observed. http://www.ncbi.nlm.nih.gov/pubmed/18184958?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

Overview

Goldberg PA, Inzucchi SE.  Critical issues in endocrinology. Clin Chest Med. 2003;24:583-606, vi. This article provides a review of the treatment of several important endocrine emergencies, including diabetic hyperglycemic states, adrenal insufficiency, myxedema coma, thyroid storm, and pituitary apoplexy. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=14710692&query_hl=19&itool=pubmed_DocSum