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December 17, 2008

Tight Glucose Control in Critically Ill Adults

JAMA. 2008;300(23):2725-2728. doi:10.1001/jama.2008.818

To the Editor: The meta-analysis of studies of tight glucose control in critically ill patients by Dr Soylemez Wiener and colleagues1 did not confirm the initial mortality benefit identified in the first trial in surgical ICU patients conducted by van den Berghe et al.2 The principal reason posited for this discrepancy was the “atypical clinical practices” of early glucose infusion and parenteral nutrition,1 although early adequate feeding of approximately 22 kcal and 1 g of protein per kilogram was accomplished.2 Adequate feeding was almost certainly not provided in other randomized trials of tight glucose control, including a second trial by van den Berghe et al3 in medical ICU patients in whom no mortality benefit was found.