Critical Care Management of Stress-Induced Hyperglycemia
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Purpose of Review
We discuss key studies that have set the scene for the debate on the efficacy and safety of tight glycemic control in critically ill patients, highlighting important differences among them, and describe the ensuing search towards strategies for safer glucose control.
Differences in level of glycemic control, glucose measurement and insulin administration, expertise, and nutritional management may explain the divergent outcomes of the landmark studies on tight glycemic control in critical illness. Regarding strategies towards safer glucose control, several computerized algorithms have shown promise, but lack validation in adequately powered outcome studies. Real-time continuous glucose monitoring and closed loop blood glucose control systems are not up to the task yet due to technical challenges, though recent advances are promising. Alternatives for insulin have only been investigated in small feasibility studies.
Severe hyperglycemia in critically ill patients generally is not tolerated anymore, but the optimal blood glucose target may depend on the specific patient and logistic context.
KeywordsCritical illness Intensive care Hyperglycemia Hypoglycemia Insulin Clinical outcome
This study was funded by structural research financing via the Methusalem program funded by the Flemish Government (grant number METH08/07 to GVdB and METH14/06 to GVdB and IV) through the University of Leuven, by a European Research Council Advanced Grant (grant number AdvG-2012- 321670) from the Ideas Programme of the EU FP7 (to GVdB), by a grant from the Research Foundation-Flanders (grant number T003617N to GVdB and JG), and by a postdoctoral research fellowship supported by the Clinical Research and Education Council of the University Hospitals Leuven (KOOR to JG).
Compliance with Ethical Standards
Conflict of Interest
Ilse Vanhorebeek, Jan Gunst, and Greet Van den Berghe declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: ••Of major importance
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