research newsSpring 2009

Landmark studies published in New England Journal of Medicine and CMAJ raise questions about ICU practicesThe Intensive Care Unit (ICU) at Vancouver General Hospital treats approximately 1100 patients a year, some of the most critically ill people in the province. Despite the very best technology and care that the ICU is able to provide, some 15% of patients die due to the severe nature of their illness. Wanting to better understand and assist survival, VGH critical care researchers have helped lead one of the largest international critical care studies ever done. Their work, published in the New England Journal of Medicine and Canadian Medical Association Journal, is changing treatment protocol in critical care units around the world.

When we become critically ill, our body does not function as well as it normally would, including the ability to produce and regulate the hormone insulin. As a result, hyperglycemia (high blood sugar levels) occurs in up to 90% of critically ill patients and is associated with increased morbidity and mortality in virtually all subgroups of intensive care unit (ICU) patients.

Based on an important study in 2001, many critical care physicians across North America and around the world believed that intervening with intensive insulin therapy (IIT) to bring blood sugar levels into a more normal range could reduce mortality by as much as 3%, and adopted this practice as a metric of competency. This intensive intervention has not been the standard of practice at VGH (where we intervene to keep blood sugar levels from getting too high, but not aggressively to bring them to a normal range), but clinical researchers here wanted more information.

Under the Canadian Critical Care Trials Group, our team jointly developed a major multinational randomized clinical trial with the Australia and New Zealand Intensive Care Society Clinical Trials Group. The combined trial is called the Normoglycaemia in Intensive Care Evaluation and Survival Using Glucose Algorithm Regulation, or the NICE-SUGAR study. It is the largest ever conducted on this topic and involved 42 hospitals from four countries and two continents.

The results, published online March 24 in the New England Journal of Medicine, show the current practice of intensively lowering blood glucose in critically ill patients actually increases the risk of death by 10 % instead of lowering it by 3% as was previously thought.

A separate research team from VGH conducted a meta-analysis of 26 trials on blood glucose levels in the ICU, including the NICE-SUGAR trial. Published online March 24 in the Canadian Medical Association Journal, researchers found no evidence that IIT reduced mortality, but they did note a 6-fold increase of hypoglycaemia (dangerously low blood sugar levels) compared to the control treatment.

The authors of both studies are calling for an urgent review of current international clinical guidelines for care in promoting IIT therapy in all crucially ill patients.

CMAJ Meta-Analysis: Dr. Don Griesdale (PI); Dr. William Henderson

NEJM, NICE-SUGAR study: Dr. Dean Chittock (PI), Dr. Vinay Dhingra, Dr. William Henderson, Dr. Juan Ronco, Dr. Peter Dodek, Denise Foster

Funding provided by the Canadian Institutes of Health Research, Australia’s National Health and Medical Research Council, the New Zealand Health Research Council, and VCH Research Institute.

Dr. Vinay Dhingra with coordinators Susan Logie and Laurie Smith and project manager Denise Foster.

Research News is published by VCH Research Institute in conjunction with VCH Communications & Public Affairs and Continuum. Contact the editor: lisa.carver@vch.ca or 604.875-4111 x 61777.

Vancouver Coastal Health Research Institute100-2647 Willow St. Vancouver, BC, V5Z 3P1

Vancouver Coastal Health Research Institute is the research body of Vancouver Coastal Health and a health partner of the University of British Columbia.

around VCH Research InstituteAnnouncing the Robert H.N. Ho Research CentreA new, state-of-the-art research centre will be established at Vancouver General Hospital, housing three internationally-recognized research programs and named after Robert H.N. Ho in honour of his $15-million donation to VGH & UBC Hospital Foundation.The building, announced by Premier Gordon Campbell, is also made possible through the support of federal

(Canada Foundation for Innovation) and provincial (BC Knowledge Development Fund) funding programs as well as support from BC’s Ministry of Health.The seven-storey, 69,350 sq. ft. (6,442 sq.m.) facility will be home to three key research programs: an expansion of the Prostate Centre at VGH; the Centre for Hip Health & Mobility; and the Ovarian Cancer Research Initiative. The building will be located adjacent to the Jack Bell Research Centre at Laurel Street and West 10th Avenue. Groundbreaking takes place July 2009.

Surgeons win the “hippest” awardA clinical research team of orthopedic surgeons from VGH and UBC have been honoured with the Hip Society’s John Charnley Award, the most prestigious award in the field of hip surgery.The John Charnley Award from the Hip Society was given to Drs. Don Garbuz (PI), Bas Masri, Nelson Greidanus, and Clive Duncan for finding that patients who underwent total hip replacement

using large-diameter heads had much higher levels of cobalt and chromium in their blood than patients who received resurfacing, a newer technique in which the damaged hip’s ball and socket are covered with smooth metal.

The study followed 107 patients in a randomized multicentre trial (Vancouver, Montreal, Red Deer) and was funded by Zimmer. This research is particularly important because hip resurfacing is the fastest growing orthopaedic surgical procedure worldwide. The results of the study will help surgeons optimize techniques for implanting hip resurfacing components.The Hip Society, founded in 1968, is an international group dedicated to advancing knowledge of the hip “in both health and distress.” The team shared the prize with another group, based at Maisonneuve-Rosemont Hospital Research Centre in Montreal, for a separate study. For full story: www.vchri.ca

Hip Health leaders part of new provincial falls prevention strategy On March 31, the Province of BC announced $100,000 to help establish the Centre of Excellence on Mobility, Fall Prevention and Injury in Aging.Established within the Centre for Hip Health & Mobility at VGH, the $100,000 funding will help these experts share their knowledge and more effectively enhance supports for seniors throughout BC. The Centre of Excellence on Mobility, Fall Prevention and Injury in Aging is a unique collaborative of researchers, health-care providers and policy makers working to improve the health and safety of older British Columbians by educating health professionals and the public. Hip Health doctors Karim Khan and Steve Robinovitch will contribute to the leadership of the new initiative.

Dr. Karim Khan with research participant in falls prevention study at the Centre for Hip Health & Mobility at VGH.

Rendering of the new Robert H.N. Ho ResearchCentre at VGH

Dr. Don Garbuz (PI) shown with patient.