Nederlands tijdschrift voor geneeskunde
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Intensive insulin therapy for critically ill patients is implemented as standard therapy in many ICUs, even though the evidence supporting this approach comes from just two studies at a single centre. Moreover, the results could not be repeated in other multicenter trials and there is increasing evidence of a risk of hypoglycaemia. However, it appears that many intensive care specialists have been too zealous in their attempts to attain euglycemia during critical care. A recent RCT with over 6000 patients demonstrated that intensive glucose control increases mortality by 2.4%.
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Ned Tijdschr Geneeskd · Jan 2009
[Total body CT scan as the primary diagnostic modality in multi-trauma patients].
Radiological imaging is highly protocolized during initial assessment of severely injured trauma patients. After an initial examination, radiography and ultrasound are performed. Imaging is frequently supplemented by CT scan of selective body areas. ⋯ Recent research on TBCT in multi-trauma patients shows promising results and several large European trauma centers have already protocolized this strategy. These studies lack a good study design, so more prospective research on clinical outcomes, cost effectiveness and radiation exposure is necessary. As part of a pilot study in preparation for a randomized multicenter study, the University Medical Centre in Amsterdam in the Netherlands is performing TBCT in severely injured trauma patients.