Surgery News - June 2008 - (Page 14)

TRAUMA SURGERY NEWS • J U N E 2 0 0 8 Burn Patients May Benefit From Insulin Therapy The control and intensive insulin therapy groups had similar blood glucose levels upon admission (142 mg/dL vs. 130 mg/dL, respectively) and in terms of daily averC I N C I N N A T I — Control of blood glucose levels age (135 mg/dL vs. 129 mg/dL) as well as overall mean through intensive insulin therapy has been shown to re- during their hospital stay (127 mg/dL vs. 126 mg/dL). duce morbidity in both surgical and medical ICU patients, The intensive insulin-treated and control groups each as well as mortality in surgical ICU patients. Results of a spent a similar percentage of time in the hospital with a retrospective study now suggest that implementation of mean daily blood glucose level greater than 140 mg/dL this therapy in burn patients may reduce the rate of in- (22% vs. 35%, respectively). But compared with the control group, patients who were treated with intensive infectious complications but not mortality. Maintaining mean blood glucose levels of less than 140 sulin therapy spent significantly less time in the hospital with a maximum mean daily blood glucose mg/dL reduced the rate of pneumonia, venlevel greater than 200 mg/dL (11% vs. 17%). tilator-associated pneumonia, and urinary In multivariate analyses that adjusted for tract infections in 71 burn patients who reage, gender, the percentage of total body surceived intensive insulin therapy, compared face area burned, and inhalation injury, adding with 81 burn patients in the same ICU during intensive insulin therapy did not significantly the year before the protocol was implementimprove the outcomes obtained in burn paed, Dr. Mark R. Hemmila said at the annual tients in the year before the therapy was immeeting of the Central Surgical Association. plemented. There were no improvements in But some discussants at the meeting quesmortality (7% vs. 9%, respectively, among intioned whether certain weaknesses in the tensive insulin vs. control patients), mean study’s design and differences in patient charA blood glucose acteristics may have contributed to its results. level greater than length of stay in the ICU (5 vs. 9 days), mean During the first year of an intensive insulin 140 mg/dL should length of stay in the hospital overall (10 vs. 17 therapy protocol ( July 2005 to June 2006), Dr. raise suspicion for days), and mean number of days requiring ventilation (3 vs. 6 days). Hemmila and his colleagues at the University an infection in But intensive insulin therapy significantly reof Michigan, Ann Arbor, sought to bring burn burn patients. duced rates of pneumonia overall (16% vs. patients’ blood glucose levels to less than 140 DR. HEMMILA 37%), ventilator-associated pneumonia (10% mg/dL. In the previous year (July 2004 to June 2005), burn patients whose blood glucose levels exceed- vs. 31%), and urinary tract infection (6% vs. 22%). The odds of developing infection were more than 11 ed 150 mg/dL had received an insulin drip protocol. The patients in each group had a mean age in the ear- times higher in patients with a maximum mean glucose ly 40s, and close to three-fourths in each group were men. of greater than 140 mg/dL than in those with a maxiThe investigators excluded patients with concomitant mum blood glucose level of 140 mg/dL or less. Of the trauma and burn injuries or desquamating skin diseases. patients with maximum blood glucose levels higher than B Y J E F F E VA N S Else vier Global Medical Ne ws 140 mg/dL, 61 had an infection and 32 did not, whereas those with blood glucose levels of 140 mg/dL comprised 6 with infection and 53 without. Based on these values, a maximum blood glucose level greater than 140 mg/dL predicted the development of infectious complications with 91% sensitivity and 62% specificity, said Dr. Hemmila, an ACS Fellow. “Measurement of a blood glucose level greater than 140 mg/dL should heighten the clinical suspicion for presence of an infection in patients with burn injury,” he said. Dr. Peter J. Fabri of the University of South Florida, Tampa, a discussant at the meeting, noted a recent study suggesting that the complication rate of tight blood glucose control may actually negate its benefits (N. Engl. J. Med. 2008;358:125-39). “We have to be very careful being critical when we look at these studies,” said Dr. Fabri, an ACS Fellow. “It’s very rare that one thing is the only thing that changes in a busy, successful critical care unit over a 2-year period of time.” Dr. Fabri said that the median length of stay was 4 days in the intensive insulin group and 12 days in the control group, which “suggests that there may, in fact, be other changes that are going on getting patients out of the unit quicker.” He also noted that the control group had a (nonsignificant) higher incidence of inhalation injury than did the intensive insulin–treated group (37% vs. 31%), as well as a higher rate of second- and third-degree burns. Dr. Hemmila said he was unaware of any particular ICU protocol changes that were made during the study period. Other discussants commented that the average total body surface area of the burns was small (19% in controls and 15% in intensive insulin–treated patients). Dr. Hemmila and some of the discussants noted that the “chicken or the egg” question of what came first— hyperglycemia or infection—is still unresolved. CLASSIFIEDS A l s o a v a i l a b l e a t w w w. e l s e v i e r h e a l t h c a r e e r s . c o m General Surgery Opportunity Arizona Kingman Regional Medical Center (KRMC) is actively recruiting for a Board Certified / Board Eligible General Surgeon. This is an employment or solo opportunity. Kingman Regional Medical Center is committed to the success of physicians we recruit to our community. Typical recruitment arrangement includes: • • • • • Reimbursement of relocation expenses Competitive salary Paid CME Vacation Full Benefit Package The hospital: Kingman Regional Medical Center is a 215 bed hospital located in Kingman, Arizona. KRMC is Mohave County’s only non-profit hospital and serves as the hub of one of our nation’s fastest growing counties. Our hospital prides itself in providing high quality, stateof-the-art care for the residents of our service area. The medical staff is comprised of over one hundred physicians representing more than 30 specialties. Technological advancements such as a 64 slice CT, PET CT, and 3.0 Tesla MRI showcase the imaging modalities available to physicians who practice in our community. KRMC is home to a new 6 room surgical suite (including a dedicated cysto room), cancer center that includes radiation and infusion therapy, sleep disorders center, and an inpatient acute rehabilitation unit. Call: Emergency on-call requirements are 7 days per month (including at least one weekend). The hospital compensates on call physician on a per-diem basis. The Location: Kingman offers to the night life of Las Vegas, the majesty of the Grand Canyon, the shopping and spas of Sedona and Scottsdale, and the beaches of Southern California. Above all, most people who are new to Kingman quickly discover what sets Kingman apart: the friendly, down-to-earth people who live here. Contact Information: For more information regarding this opportunity, please contact: Janet Ackerman, KRMC Physician Recruiter, Telephone: 928-681-8595 e-mail: jackerman@azkrmc.com FOR CLASSIFIED RATES AND INFORMATION: Danny Wang Elsevier-Surgery News 360 Park Avenue South New York, NY 10010 (212) 633-3158 FAX: (212) 633-3820 Email ad to: d.wang@elsevier.com Project HOPE Improving Health Through Education Give to Dept. A, Washington, D.C. 20007 Disclaimer SURGERY NEWS assumes the statements made in classified advertisements are accurate, but cannot investigate the statements and assumes no responsibility or liability concerning their content. The Publisher reserves the right to decline, withdraw, or edit advertisements. 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Surgery News - June 2008

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