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

Background Acute hyperglycemia in ICU patients is associated with increased risk of nosocomial infections by raised plasma levels of proinflammatory cytokines, stimulates muscle protein degradation, and inhibits 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, aging between 20 and 70 years, admitted to the 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 radiography, random blood sugar, HbA1C, and serum K^+ were recorded at the time of ICU admission. Patients were divided into two groups according to patient approval. Group I includes 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), in which the standard of care was 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 sings, C-reactive protein, and chest radiography) was carried out 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). With regard to the duration of ICU stay, there was a statistically significant higher rate of ICU stay for more than 7 days among patients of group II (P 0.001). Comparing between the incidence of chest infection in group I and group II, there was low incidence of chest infection in group I [four patients (4%)], whereas 18 patients (18%) of group II (22 of 200 patients) showed chest infection (P = 0.003). Conclusion We concluded that euglycemic control reduces the incidence of chest infection in ICU patients.