PMID: 16639074Apr 28, 2006Paper

Hyperglycemia during critical illness

JPEN. Journal of Parenteral and Enteral Nutrition
Stanley A Nasraway

Abstract

We sought to review the literature describing the benefits of tight glycemic control in critically ill patients, comparing outcome differences in subgroup populations. We searched PubMed for relevant literature on the topic of hyperglycemia and its management in the intensive care unit. Overwhelming evidence in both surgical and medical patients conclusively demonstrates that hyperglycemia is a marker of severity of illness and is also an independent determinant of bad outcome, largely from infectious complications. Randomized trial evidence, in conjunction with historically controlled trials, supports the use of intensive insulin therapy and euglycemic control in critically ill patients, with nondiabetics possibly benefiting even more than diabetic patients. Euglycemia is best achieved, and hypoglycemia attenuated, through use of a protocolized approach. Further elaboration as to what threshold range defines euglycemia in patient subpopulations is needed and what pitfalls must be avoided in this practice. Development of continuous blood glucose monitoring has started and will someday be incorporated into routine practice in the same way that continuous electrocardiographic monitoring and pulse oximetry are standards of care in...Continue Reading

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Citations

Nov 24, 2007·Der Anaesthesist·B EllgerG Van den Berghe
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