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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.

The most rigorous meta-analysis⁴ of adequate nutritional support in critically ill patients using an intention-to-treat analysis showed a significant increase of infectious complications but a significant reduction in mortality with total parenteral nutrition compared . . . [Full Text of this Article]

Bruce Ryan Bistrian, MD, PhD
bbistria@bidmc.harvard.edu
Department of Medicine
Beth Israel Deaconess Medical Center
Boston, Massachusetts

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