First, it doesn’t necessarily take 10-15 years for the literature to “mature”. This particular time period came from the IOM report citing that it takes approximately 15 years for us to broadly implement a practice of medicine that we do know to be safe and effective based on the literature.

However, that being said, the literature on this particular issue was not even close to being vetted prior to its firestorm introduction into our ICUs. The Van den Berghe article published in the NEJM in 2001 was fantastic in its risk reduction in mortality. For reasons unclear to me, this single article was picked up by the intensivist professionals and enacted with vigor. There were many subsequent articles following the original that clearly debated its findings and put into question its methods. In this case we should have waited before we broadly implemented the particular strategy used in the original study.

Therefore, I want to caution the readers that this particular instance of tight glycemic control in the critically ill population is not a story that should slow down the push for EBM practice. In fact, this is a story of implementing a strategy of therapy essentially based on a single study because at face value it appeared to be plausible AND easy to do. In reality neither were true.

JFS