Glucose control in the intensive care unit: how it is done

Area of Science:

• Critical Care Medicine
• Endocrinology
• Metabolic Disorders

Background:

• Hyperglycaemia is common in critically-ill patients due to hypercatabolism and insulin resistance.
• Elevated blood glucose levels in critical illness are linked to increased mortality and complications.
• Previous studies suggested 'tight' glycaemic control (4.1-6.4 mmol/l) could decrease mortality.

Purpose of the Study:

• To review the current practice of glycaemic control in intensive care units.
• To highlight the challenges and necessary precautions for safe glucose management.
• To discuss the evolution of glycaemic control targets in critical care.

Main Methods:

• Current clinical practice guidelines and expert consensus on glycaemic control.
• Review of protocols for insulin and energy administration in critically-ill patients.
• Emphasis on frequent glucose monitoring and visual charting for patient management.

Main Results:

• Initial enthusiasm for 'tight' glycaemic control led to risks of severe hypoglycaemia.
• Current practice favors a broader glucose control range (4-8 mmol/l) to balance efficacy and safety.
• Safe implementation necessitates careful attention to energy provision and insulin dosing adjustments.

Conclusions:

• Glycaemic control in critical illness requires meticulous attention to detail for safe and effective management.
• A balanced approach to glucose targets (4-8 mmol/l) is currently favored over very strict control.
• Ongoing research will further define the optimal role of glycaemic control in critical care settings.