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Intensive insulin therapy and pentastarch resuscitation in severe sepsis.
N Engl J Med. 2008 Jan 10;358(2):125-39.
Brunkhorst FM, Engel C, Bloos F, Meier-Hellmann A, Ragaller M, Weiler N, Moerer O, Gruendling M, Oppert M, Grond S, Olthoff D, Jaschinski U, John S, Rossaint R, Welte T, Schaefer M, Kern P, Kuhnt E, Kiehntopf M, Hartog C, Natanson C, Loeffler M, Reinhart K; German Competence Network Sepsis (SepNet).
Department of Anesthesiology and Intensive Care Medicine, Friedrich Schiller University, Jena, Germany.
BACKGROUND:
The role of intensive insulin therapy in patients with severe sepsis is
uncertain. Fluid resuscitation improves survival among patients with
septic shock, but evidence is lacking to support the choice of either
crystalloids or colloids. METHODS: In a multicenter, two-by-two
factorial trial, we randomly assigned patients with severe sepsis to
receive either intensive insulin therapy to maintain euglycemia or
conventional insulin therapy and either 10% pentastarch, a
low-molecular-weight hydroxyethyl starch (HES 200/0.5), or modified
Ringer's lactate for fluid resuscitation. The rate of death at 28 days
and the mean score for organ failure were coprimary end points.
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