Glucose control in the ICU.

PURPOSE OF REVIEW Critically ill patients usually develop hyperglycemia, which is associated with adverse outcome. Controversy exists whether the relationship is causal or not. This review summarizes recent evidence regarding glucose control in the ICU. RECENT FINDINGS Despite promising effects of tight glucose control in pioneer randomized controlled trials, the benefit has not been confirmed in subsequent multicenter studies and one trial found potential harm. This discrepancy could be explained by methodological differences between the trials rather than by a different case mix. Strategies to improve the efficacy and safety of tight glucose control have been developed, including the use of computerized treatment algorithms. SUMMARY The ideal blood glucose target remains unclear and may depend on the context. As compared with tolerating severe hyperglycemia, tight glucose control is well tolerated and effective in patients receiving early parenteral nutrition when provided with a protocol that includes frequent, accurate glucose measurements and avoids large glucose fluctuations. All patient subgroups potentially benefit, with the possible exception of patients with poorly controlled diabetes, who may need less aggressive glucose control. It remains unclear whether tight glucose control is beneficial or not in the absence of early parenteral nutrition.

[1]  R. Hovorka,et al.  Improving glycemic control in critically ill patients: personalized care to mimic the endocrine pancreas , 2018, Critical Care.

[2]  J. Vincent,et al.  Near-Continuous Glucose Monitoring Makes Glycemic Control Safer in ICU Patients* , 2018, Critical care medicine.

[3]  B. De Moor,et al.  Software-guided versus nurse-directed blood glucose control in critically ill patients: the LOGIC-2 multicenter randomized controlled clinical trial , 2017, Critical Care.

[4]  P. Kalfon,et al.  Continuous glucose monitoring in the ICU: clinical considerations and consensus , 2017, Critical Care.

[5]  V. Nadkarni,et al.  Tight Glycemic Control in Critically Ill Children , 2017, The New England journal of medicine.

[6]  R. Hovorka,et al.  Glucose Control in the ICU , 2016, Journal of diabetes science and technology.

[7]  J. Preiser,et al.  Glycemic control: please agree to disagree , 2016, Intensive Care Medicine.

[8]  G. Van den Berghe,et al.  Blood glucose control in the ICU: don’t throw out the baby with the bathwater! , 2016, Intensive Care Medicine.

[9]  P. Marik.  Tight glycemic control in acutely ill patients: low evidence of benefit, high evidence of harm! , 2016, Intensive Care Medicine.

[10]  T. Kirby.  Early versus late parenteral nutrition in critically ill children. , 2016, The Lancet. Respiratory medicine.

[11]  Balázs Benyó,et al.  Safety, efficacy and clinical generalization of the STAR protocol: a retrospective analysis , 2016, Annals of Intensive Care.

[12]  R. Bellomo,et al.  Pre-morbid glycemic control modifies the interaction between acute hypoglycemia and mortality , 2016, Intensive Care Medicine.

[13]  D. Cook,et al.  Intensive versus conventional glucose control in critically ill patients with traumatic brain injury: long-term follow-up of a subgroup of patients from the NICE-SUGAR study , 2015, Intensive Care Medicine.

[14]  K. Hanazaki,et al.  Intensive Versus Intermediate Glucose Control in Surgical Intensive Care Unit Patients , 2014, Diabetes Care.

[15]  R. Bellomo,et al.  Dysglycaemia in the critically ill and the interaction of chronic and acute glycaemia with mortality , 2014, Intensive Care Medicine.

[16]  R. Grieve,et al.  A randomized trial of hyperglycemic control in pediatric intensive care. , 2014, The New England journal of medicine.

[17]  M. Sorine,et al.  Tight computerized versus conventional glucose control in the ICU: a randomized controlled trial , 2014, Intensive Care Medicine.

[18]  Roman Hovorka,et al.  Feasibility of fully automated closed-loop glucose control using continuous subcutaneous glucose measurements in critical illness: a randomized controlled trial , 2013, Critical Care.

[19]  Roman Hovorka,et al.  Clinical review: Consensus recommendations on measurement of blood glucose and reporting glycemic control in critically ill adults , 2013, Critical Care.

[20]  L. Lagae,et al.  Neurocognitive Development of Children 4 Years After Critical Illness and Treatment With Tight Glucose Control: A Randomized Controlled Trial , 2013 .

[21]  A. Kiss,et al.  Diabetic status and the relation of the three domains of glycemic control to mortality in critically ill patients: an international multicenter cohort study , 2013, Critical Care.

[22]  F. Pigula,et al.  Tight glycemic control versus standard care after pediatric cardiac surgery. , 2012, The New England journal of medicine.

[23]  John A Myburgh,et al.  Hypoglycemia and risk of death in critically ill patients. , 2012, The New England journal of medicine.

[24]  J. Daly.  Early versus late Parenteral Nutrition in Critically Ill Adults , 2012 .

[25]  K. Hanazaki,et al.  The evaluation of the ability of closed-loop glycemic control device to maintain the blood glucose concentration in intensive care unit patients* , 2011, Critical care medicine.

[26]  R. Bellomo,et al.  The interaction of chronic and acute glycemia with mortality in critically ill patients with diabetes* , 2011, Critical care medicine.

[27]  G. Van den Berghe,et al.  Glucose dysregulation and neurological injury biomarkers in critically ill children. , 2010, The Journal of clinical endocrinology and metabolism.

[28]  J. Preiser,et al.  International recommendations for glucose control in adult non diabetic critically ill patients , 2010, Critical care.

[29]  D. Herndon,et al.  Intensive insulin therapy in severely burned pediatric patients: a prospective randomized trial. , 2010, American journal of respiratory and critical care medicine.

[30]  P. Marik,et al.  Original ResearchCritical Care MedicineToward Understanding Tight Glycemic Control in the ICU: A Systematic Review and Metaanalysis , 2010 .

[31]  G. Van den Berghe,et al.  Blood Glucose Control in the Intensive Care Unit: Benefits and Risks , 2010, Seminars in dialysis.

[32]  D. Annane,et al.  Corticosteroid treatment and intensive insulin therapy for septic shock in adults: a randomized controlled trial. , 2010, JAMA.

[33]  F. Ovalle.  Hyperglycemia–related mortality in critically ill patients varies with admission diagnosis , 2010 .

[34]  Harald Herkner,et al.  Real-Time Continuous Glucose Monitoring in Critically Ill Patients , 2009, Diabetes Care.

[35]  G. Van den Berghe,et al.  Hyperglycemic kidney damage in an animal model of prolonged critical illness. , 2009, Kidney international.

[36]  Johan Groeneveld,et al.  A prospective randomised multi-centre controlled trial on tight glucose control by intensive insulin therapy in adult intensive care units: the Glucontrol study , 2009, Intensive Care Medicine.

[37]  O. Tanner.  Intensive versus Conventional Glucose Control in Critically Ill Patients , 2009 .

[38]  Roberto Delfini,et al.  Safety and Efficacy of Intensive Insulin Therapy in Critical Neurosurgical Patients , 2009, Anesthesiology.

[39]  Greet Van den Berghe,et al.  Intensive insulin therapy for patients in paediatric intensive care: a prospective, randomised controlled study , 2009, The Lancet.

[40]  L. Foubert,et al.  Tight perioperative glucose control is associated with a reduction in renal impairment and renal failure in non-diabetic cardiac surgical patients , 2008, Critical care.

[41]  Rolf Rossaint,et al.  Intensive insulin therapy and pentastarch resuscitation in severe sepsis. , 2008, The New England journal of medicine.

[42]  N. Khardori.  Intensive Insulin Therapy and Pentastarch Resuscitation in Severe Sepsis , 2008 .

[43]  F. Bilotta,et al.  The Effect of Intensive Insulin Therapy on Infection Rate, Vasospasm, Neurologic Outcome, and Mortality in Neurointensive Care Unit After Intracranial Aneurysm Clipping in Patients With Acute Subarachnoid Hemorrhage: A Randomized Prospective Pilot Trial , 2007, Journal of neurosurgical anesthesiology.

[44]  Sang Won Suh,et al.  Hypoglycemic neuronal death is triggered by glucose reperfusion and activation of neuronal NADPH oxidase. , 2007, The Journal of clinical investigation.

[45]  J. Krinsley.  Glycemic control, diabetic status, and mortality in a heterogeneous population of critically ill patients before and during the era of intensive glycemic management: six and one-half years experience at a university-affiliated community hospital. , 2006, Seminars in thoracic and cardiovascular surgery.

[46]  E. de Jonge,et al.  Evaluation of short-term consequences of hypoglycemia in an intensive care unit* , 2006, Critical care medicine.

[47]  Miet Schetz,et al.  Strict blood glucose control with insulin during intensive care after cardiac surgery: impact on 4-years survival, dependency on medical care, and quality-of-life. , 2006, European heart journal.

[48]  Miet Schetz,et al.  Intensive Insulin Therapy in Mixed Medical/Surgical Intensive Care Units , 2006, Diabetes.

[49]  G. Van den Berghe,et al.  Survival benefits of intensive insulin therapy in critical illness: impact of maintaining normoglycemia versus glycemia-independent actions of insulin. , 2006, Diabetes.

[50]  G. Van den Berghe,et al.  Analysis of healthcare resource utilization with intensive insulin therapy in critically ill patients* , 2006, Critical care medicine.

[51]  Scott K Aberegg,et al.  Intensive insulin therapy in the medical ICU. , 2006, The New England journal of medicine.

[52]  Miet Schetz,et al.  Outcome benefit of intensive insulin therapy in the critically ill: Insulin dose versus glycemic control* , 2003, Critical care medicine.

[53]  G. V. Berghe,et al.  Intensive insulin therapy in critically ill patients. , 2001, The New England journal of medicine.