Euglycemic control: does it affect the incidence of chest infection in ICU patients?

Background Acute hyperglycemia in ICU patients is associated with increased risk for nosocomial infections by raising plasma levels of proinflammatory cytokines, stimulating muscle-protein degradation, and inhibiting protein synthesis, which could contribute to muscle wasting. Euglycemic control with insulin reduced septicemia and the need for prolonged antibiotic therapy, prevented nosocomial infection, accelerated resolution of inflammation, and reduced muscle catabolism. Patients and methods A total of 200 patients of both sex, diabetic or nondiabetic, aged 20–70 years admitted to ICU of Ain Shams University Hospitals for more than 2 days who gave written and informed consent were enrolled in the study. Age, sex, clinical assessment for chest infection, C-reactive protein, chest radiograph, random blood sugar, HbA1C, and serum potassium were recorded at the time of ICU admission. Patients were divided into two groups. Group I was the euglycemic control group (n = 100 patients) in which blood sugar was kept between 100 and 120 mg/dl using regular insulin infusion and group II (n = 100 patients) received the standard care using an intravenous insulin infusion titrated to maintain blood glucose between 120 and 180 mg/ dl. Blood sugar was measured every 1 h in both groups; indicator of chest infection (clinical signs, C-reactive protein, and chest radiography) was performed daily. Results Regarding all demographic data (age and sex), there were no statistically significant differences between the studied groups (P = 0.744 and 0.730, respectively). Regarding duration of ICU stay, there was a significantly higher rate of ICU stay for more than 7 days among patients of group II (P 0.001). Comparing the incidence of chest infection in group I and group II, there was low incidence of chest infection in four patients (4%) of group I , whereas 18 patients (18%) of group II (22 of 200 patients) showed chest infection (P 0.003). Conclusion Euglycemic control reduces the incidence of chest infection in ICU patients.