Old way best in treating critically ill

Intensive care units throughout much of the world are expected to revert

to an old method of treating patients after a study that included 1200 New Zealand patients showed it saved more lives.

The study of how best to manage high blood-sugar levels in the critically ill found that a relatively new treatment called intensive insulin therapy has a 10 per cent higher death rate than the conventional treatment, which is also much cheaper.

The normal blood-sugar range in a healthy person is 4.5 to 6.1 millimoles per litre, but the level often soars in the critically ill.

Conventional ICU practice is to infuse insulin to reduce the blood-sugar level if it goes over 10 and stop if it drops under 8. Under intensive insulin therapy the target range is much lower: 4.5 to 6 millimoles a litre.

Intensive insulin therapy became the norm in many parts of the world after a 2001 study indicated it could reduce the death rate among intensive care unit patients who had high blood-sugar.

But it was much less widely adopted in New Zealand, said an Auckland City Hospital specialist involved in the latest study, Dr Shay McGuinness.

"I think most clinicians in New Zealand felt it was controversial, even though it was widely accepted [internationally], and that was the driving force for doing this study," said Dr McGuinness, a specialist in the hospital's cardiothoracic and vascular intensive care unit.

He said the result of the study was a surprise.

But even if, as had been expected, it showed no mortality difference between the two treatment approaches, it would in effect have endorsed the conventional practice because it was much cheaper.

And since it was a large, powerful study, it was now expected to lead an international change back to conventional therapy.

THE STUDY
* Published yesterday in New England Journal of Medicine.
* 6104 critically ill patients at intensive care units in NZ, Australia, Canada and the US were followed for up to 90 days.
* The critically ill commonly have high blood-sugar levels.
* In the study, patients' blood sugar levels were managed with insulin either conventionally, or with intensive therapy to a much lower level.
* The conventional group's rate of death within 90 days was 24.9 per cent.
* The intensive insulin therapy group's rate was 27.5 per cent - 10 per cent higher.