{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T21:16:44Z","timestamp":1785446204600,"version":"3.56.0"},"reference-count":22,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2009,12,9]],"date-time":"2009-12-09T00:00:00Z","timestamp":1260316800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/2.0\/"},{"start":{"date-parts":[[2009,12,9]],"date-time":"2009-12-09T00:00:00Z","timestamp":1260316800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/2.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Crit Care"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                        <jats:title>Introduction<\/jats:title>\n                        <jats:p>Intensive insulin treatment of critically ill patients was seen as a promising method of treatment, though recent studies showed that reducing the blood glucose level below 6 mmol\/l had a detrimental outcome. The mechanisms of the effects of insulin in the critically ill are not completely understood. The purpose of the study was to test the hypothesis that intensive insulin treatment may influence forearm blood flow independently of global hemodynamic indicators.<\/jats:p>\n                     <\/jats:sec><jats:sec>\n                        <jats:title>Methods<\/jats:title>\n                        <jats:p>The study encompassed 29 patients of both sexes who were admitted to the intensive care unit due to sepsis and required artificial ventilation as the result of acute respiratory failure. 14 patients were randomly selected for intensive insulin treatment (Group 1; blood glucose concentration 4.4-6.1 mmol\/l), and 15 were selected for conventional insulin treatment (Group 2; blood glucose level 7.0 mmol\/l-11.0 mmol\/l). At the start of the study (t<jats:sub>0<\/jats:sub>, beginning up to 48 hours after admittance and the commencement of artificial ventilation), at 2 hours (t<jats:sub>1<\/jats:sub>), 24 hours (t<jats:sub>2<\/jats:sub>), and 72 hours (t<jats:sub>3<\/jats:sub>) flow in the forearm was measured for 60 minutes using the strain-gauge plethysmography method. Student's t-test of independent samples was used for comparisons between the two groups, and Mann-Whitney's U-test where appropriate. Linear regression analysis and the Pearson correlation coefficient were used to determine the levels of correlation.<\/jats:p>\n                     <\/jats:sec><jats:sec>\n                        <jats:title>Results<\/jats:title>\n                        <jats:p>The difference in 60-minute forearm flow at the start of the study (t<jats:sub>0<\/jats:sub>) was not statistically significant between groups, while at t<jats:sub>2<\/jats:sub> and t<jats:sub>3<\/jats:sub> significantly higher values were recorded in Group 1 (t<jats:sub>2<\/jats:sub>; Group 1: 420.6 \u00b1 188.8 ml\/100 ml tissue; Group 2: 266.1 \u00b1 122.2 ml\/100 ml tissue (95% CI 30.9-278.0, <jats:italic>P<\/jats:italic> = 0.02); t<jats:sub>3<\/jats:sub>; Group 1: 369.9 \u00b1 150.3 ml\/100 ml tissue; Group 2: 272.6 \u00b1 85.7 ml\/100 ml tissue (95% CI 5.4-190.0, <jats:italic>P<\/jats:italic> = 0.04). At t<jats:sub>1<\/jats:sub> a trend towards significantly higher values in Group 1 was noted (<jats:italic>P<\/jats:italic> = 0.05). The level of forearm flow was related to the amount of insulin infusion (r = 0.40).<\/jats:p>\n                     <\/jats:sec><jats:sec>\n                        <jats:title>Conclusions<\/jats:title>\n                        <jats:p>Compared to standard treatment, intensive insulin treatment of critically ill patients increases forearm flow. Flow increase was weakly related to the insulin dose, though not to blood glucose concentration.<\/jats:p>\n                     <\/jats:sec><jats:sec>\n                        <jats:title>Trial Registration<\/jats:title>\n                        <jats:p>Trial number: ISRCTN39026810.<\/jats:p>\n                     <\/jats:sec>","DOI":"10.1186\/cc8202","type":"journal-article","created":{"date-parts":[[2009,12,10]],"date-time":"2009-12-10T12:54:47Z","timestamp":1260449687000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Intensive insulin treatment improves forearm blood flow in critically ill patients: a randomized parallel design clinical trial"],"prefix":"10.1186","volume":"13","author":[{"given":"Ivan","family":"\u017duran","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pavel","family":"Poredo\u0161","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafael","family":"Skale","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gorazd","family":"Voga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucija","family":"Gabr\u0161\u010dek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roman","family":"Pare\u017enik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2009,12,9]]},"reference":[{"key":"7623_CR1","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1016\/S0749-0704(05)70154-8","volume":"17","author":"K McCowen","year":"2001","unstructured":"McCowen K, Malhotra A, Bistrian BR: Stress-induced hyperglycemia.\n                           Crit Care Clin 2001, 17: 107-124. 10.1016\/S0749-0704(05)70154-8","journal-title":"Crit Care Clin"},{"key":"7623_CR2","doi-asserted-by":"publisher","first-page":"516","DOI":"10.1056\/NEJMe058304","volume":"354","author":"A Malhotra","year":"2006","unstructured":"Malhotra A: Intensive insulin in intensive care.\n                           N Engl J Med 2006, 354: 516-518. 10.1056\/NEJMe058304","journal-title":"N Engl J Med"},{"key":"7623_CR3","doi-asserted-by":"publisher","first-page":"1359","DOI":"10.1056\/NEJMoa011300","volume":"345","author":"GVan den Berghe","year":"2001","unstructured":"Berghe G, Wouters P, Weekers F, Verwaest Ch, Bruyninckx F, Schetz M, Vlasslaers D, Ferdinande P, Lauwers P, Bouillon R: Intensive insulin therapy in critically ill patients.\n                           N Engl J Med 2001, 345: 1359-1367. 10.1056\/NEJMoa011300","journal-title":"N Engl J Med"},{"key":"7623_CR4","doi-asserted-by":"publisher","first-page":"449","DOI":"10.1056\/NEJMoa052521","volume":"354","author":"GVan den Berghe","year":"2006","unstructured":"Berghe G, Wilmer A, Hermans G, Meerseman W, Wouters PJ, Milants I, Van Wijngaerden E, Bobbaers H, Bouillon R: Intensive insulin therapy in the medical ICU.\n                           N Engl J Med 2006, 354: 449-461. 10.1056\/NEJMoa052521","journal-title":"N Engl J Med"},{"key":"7623_CR5","doi-asserted-by":"publisher","first-page":"1283","DOI":"10.1056\/NEJMoa0810625","volume":"360","author":"S Finfer","year":"2009","unstructured":"Finfer S, Chittock R, Yu-Shuo Su S, Blair D, Foster D, Dhingra V, Bellomo R, Cook D, Dodek P, Henderson WR, H\u00e9bert PC, Heritier S, Heyland DK, McArthur C, McDonald E, Mitchell I, Myburgh JA, Norton R, Potter J, Robinson BG, Ronco JJ: Intensive versus conventional glucose control in critically ill patients.\n                           N Engl J Med 2009, 360: 1283-1297. 10.1056\/NEJMoa0810625","journal-title":"N Engl J Med"},{"key":"7623_CR6","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1056\/NEJMoa070716","volume":"358","author":"FM Brunkhorst","year":"2008","unstructured":"Brunkhorst FM, Engel Ch, 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 Ch, Natanson Ch, Loeffler M, Reinhardt K: Intensive insulin therapy and pentastarch resuscitation in severe sepsis.\n                           N Engl J Med 2008, 358: 125-139. 10.1056\/NEJMoa070716","journal-title":"N Engl J Med"},{"key":"7623_CR7","doi-asserted-by":"publisher","first-page":"1888","DOI":"10.1161\/CIRCULATIONAHA.105.563213","volume":"113","author":"JA Kim","year":"2006","unstructured":"Kim JA, Montagnani M, Koh KK, Quon MJ: Reciprocal relationship between insulin resistance and endothelial dysfunction. 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