Evidence map›Paper›PMID 18373223›Full record

Trial reportNeurocritical care2008

Intensive insulin therapy after severe traumatic brain injury: a randomized clinical trial.

Federico Bilotta, Remo Caramia, Ibolja Cernak, Francesca Paola Paoloni, Andrea Doronzio, Vincenzo Cuzzone, Antonio Santoro, Giovanni Rosa

Abstract readRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in Neurocritical care, 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 78 papers, 8 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
78citing papers in PubMed, 8 pooled it
10.9field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

78 citing papers in PubMed, 8 syntheses or guidelines pooled it, 205 citations in OpenAlex.

  1. Pooled it
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  8. Intensive insulin therapy and mortality among critically ill patients: a meta-analysis including NICE-SUGAR study data.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2009
    Pooled it
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  16. Diabetes Management Strategies in Intensive Care Settings.The Medical clinics of North America · 2026
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18 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 3 institutions in 2 countries.

Federico BilottaDepartment of Anesthesiology, Critical Care and Pain Medicine, La Sapienza University of Rome, Viale Somalia 81, Rome, 00199, Italy. bilotta@tiscali.it
Remo Caramia
Ibolja Cernak
Francesca Paola Paoloni
Andrea Doronzio
Vincenzo Cuzzone
Antonio Santoro
Giovanni Rosa
Sapienza University of Rome · ITFondazione Gimema Onlus · ITJohns Hopkins University Applied Physics Laboratory · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionTo investigate the risks and possible benefits of routine versus intensive insulin therapy, assessed by the frequency of hypoglycemic events defined as a glucose concentration less than 80 mg/dl (<4.44 mmol/l) in patients admitted to the intensive care unit (ICU) after severe traumatic brain injury (TBI). METHODS AND

resultsNinety-seven patients admitted after severe TBI, were enrolled and randomly assigned to two groups of target glycemia. Insulin was infused at conventional rates when blood glucose levels exceeded 220 mg/dl (12.22 mmol/l) or at intensive rates, to maintain glycemia at 80-120 mg/dl (4.44-6.66 mmol/l). The following primary and outcome variables were measured during follow-up: hypoglycemic episodes, duration of ICU stay, infection rate, and 6-month mortality and neurologic outcome measured using the Glasgow Outcome Scale (GOS). Episodes of hypoglycemia (defined as blood glucose <80 mg/dl or 4.44 mmol/l) were significantly higher in patients receiving intensive insulin therapy: median (min-max) conventional insulin therapy 7 (range 0-11) vs. intensive insulin therapy 15 (range 6-33); P<0.0001. Duration of ICU stay was shorter in patients receiving intensive insulin therapy (7.3 vs. 10.0 days; P < 0.05); while infection rates during ICU stay (25.0% vs. 38.8%, P = 0.15), and GOS scores and mortality at 6 months were similar in the two groups.

conclusionsIntensive insulin therapy significantly increases the risk of hypoglycemic episodes. Even though patients receiving intensive insulin therapy have shorter ICU stays and infection rates similar to those receiving conventional insulin therapy, both groups have similar follow-up mortality and neurologic outcome. Hence if intensive insulin therapy is to be used, great effort must be taken to avoid hypoglycemia.

Indexed as

AdultAgedBlood GlucoseBrain InjuriesCritical CareFemaleGlasgow Coma ScaleHumansHypoglycemiaHypoglycemic AgentsInfectionsInsulinMaleMiddle AgedProspective StudiesRisk FactorsBlood GlucoseHypoglycemic AgentsInsulin

Identifiers

PMID18373223
OpenAlexW2082477419

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.