Early Insulin and Development of ARDS

ALI/ARDS is a life-threatening condition that involves inflammation of the lungs and fluid
accumulation in the air sacs, leading to low blood oxygen levels and respiratory failure.
Common causes include pneumonia, lung trauma, and sepsis, a condition that can lead to
widespread inflammation and blood clotting in response to an infection. Recent studies have
shown that insulin, which is regularly used to control blood sugar levels, may prevent or
lessen the risk of lung tissue inflammation and/or lung injury related to sepsis. Research
has shown that critically ill ICU patients often benefit from receiving insulin to target
80-110 mg/dl , but it is not known if insulin to target these levels can prevent the onset of
ALI/ARDS. Therapies to prevent ALI/ARDS should occur early, preferably even prior to ICU
admission, because at least 38% of people with ALI/ARDS are diagnosed with the condition once
they reach the ICU. The purpose of this study is to determine whether insulin to target
80-110 mg/dl administered to critically ill patients in the emergency department (ED) is more
beneficial at preventing ALI/ARDS than insulin to target 150-180 mg/dl after ICU admission.

This study will enroll people who are hospitalized with high blood sugar levels and severe
sepsis. Participants will be randomly assigned to receive IIT within 6-12 hours of ED
presentation to target 80-110 mg/dl or target 150-180 mg/dl for 48 hours after admission to
the ICU followed by usual care. Prior to ICU admission and 1, 3, and 7 days after ICU
admission, blood will be collected and analyzed for markers of inflammation and lung injury.
Blood samples will be stored for future research studies. While participants are in the
hospital, their medical records will be reviewed to gather information on medical and family
history, demographics, vital signs, laboratory test results, x-ray findings, and lung
function. Study researchers will also monitor participants for the development of severe lung
failure or other organ failures.

Inclusion Criteria:

- Diagnosed with severe sepsis, which is defined as sepsis AND one or more signs of
organ dysfunction or hypotension

- Hyperglycemia (i.e., glucose level greater than 130 mg/dL on one or more tests)

Exclusion Criteria:

- Diabetic ketoacidosis

- Severe chronic liver disease with Child-Pugh score greater than 10 (Class C)

- Documented episodes of blood or plasma glucose less than 60 mg/dL within 24 hours of
study entry

- Lack of any available IV access for insulin infusion

- Pregnant

- Known advanced directives against intubation or aggressive ICU care

- Inability to be enrolled into the study in the 12 hours following admission to the ED