Hyperglycemia During Critical Illness

• Published in: JPEN. Journal of parenteral and enteral nutrition Vol. 30; no. 3; pp. 254 - 258
• Main Author: Nasraway, Stanley A.
• Format: Book Review Journal Article
• Language: English
• Published: Silver Spring, MD SAGE Publications 01.05.2006; ASPEN; American Society for Parenteral and Enteral Nutrition
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antibacterial agents; Antibiotics. Antiinfectious agents. Antiparasitic agents; Biological and medical sciences; Biomarkers; Blood Glucose - metabolism; Critical Care - methods; Critical Illness; Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition; Humans; Hyperglycemia - complications; Hyperglycemia - mortality; Hypoglycemic Agents - therapeutic use; Insulin - therapeutic use; Intensive care medicine; Intensive Care Units; Medical sciences; Miscellaneous; Pharmacology. Drug treatments; Severity of Illness Index; Survival Analysis; Treatment Outcome; Hyperglycemia; Nutrition; Enteral administration; Parenteral administration; Feeding
• ISSN: 0148-6071; 1941-2444
• DOI: 10.1177/0148607106030003254

Background: We sought to review the literature describing the benefits of tight glycemic control in critically ill patients, comparing outcome differences in subgroup populations. Methods: We searched PubMed for relevant literature on the topic of hyperglycemia and its management in the intensive care unit. Results: 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 the intensive care unit. Conclusions: Hyperglycemia is a predictor of death and complications in critically ill patients. Early aggregated study results show that control of hyperglycemia improves outcomes. Well-designed studies involving thousands of patients have started to better elucidate the concomitant promoters of hyperglycemia and to better quantify the benefits from tight glycemic control. Salient literature is reviewed describing the benefits of tight glycemic control in critically ill patients, comparing outcome differences in subgroup populations. Hypoglycemia and other pitfalls with implementation of an intensive insulin protocol are discussed.