PMID: 19927500Nov 26, 2009Paper

Glucose control and its implications for the general surgeon.

The American Surgeon
Maya Leggett, Brian G Harbrecht

Abstract

In the face of these conflicting data, how should the practicing surgeon approach the issue of tight glucose control in their critically ill surgical patients? The answer to that question may well change over time as new data emerge. For now, however, it seems reasonable to conclude that tight glucose control to the normal range (80-110 mg/dL) in critically ill general surgery patients (i.e., the Van den Berghe model) is an intriguing but unproven hypothesis that needs to be confirmed by prospective randomized trials in different ICUs and in a relevant patient population. It is quite possible, and probably likely, that levels of hyperglycemia that were previously thought to be inconsequential (180-200 mg/dL) may be harmful when sustained over prolonged periods of time and that better glucose control in the ICU than previously practiced is merited. However, given the detrimental effects of hypoglycemia, great care must be exercised in trying to achieve better glucose control so as not to induce harm. Technical considerations such as differences in glucose measuring systems, use of morning versus all glucose values, and nutritional regimens all need to be considered. The ICU is by definition a complex environment involving multip...Continue Reading

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