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In Reply: Dr Moshenyat and colleagues point out that our study predominantly examined patients admitted following cardiac surgery and that there were differences in mortality between those admitted for medical vs surgical diagnoses. Indeed, we discussed this as a potential limitation of our investigation. Nevertheless, as stated, we believe that our observations are important, as a large proportion of patients in the ICU are in the postoperative period of cardiac surgery. Furthermore, we have observed that such patients may have medical complications and comorbidities that affect their outcome. This may add value to our results for the general ICU population.

We agree with Dr van der Horst and colleagues that lower glucose levels may be a surrogate for other event factors, such as improvement in dyslipidemia. Because insulin is titrated at the bedside to blood glucose levels, however, these parameters would seem the most appropriate therapeutic targets to assess. Our . . . [Full Text of this Article]

Simon J. Finney, MBChB, MRCP; Timothy W. Evans, MD, DSc, FRCP
Adult Intensive Care Unit
Royal Brompton Hospital
London, England

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