Evaluation of short-term consequences of hypoglycemia in an intensive care unit*

Thomas, Alain; Boxall, Emma M.; Twamley, Huw W. J.

doi:10.1097/01.ccm.0000241155.36689.91

Cited by 200 publications

(107 citation statements)

References 15 publications

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“…When correcting for patient risk factors and duration of exposure to insulin (ICU stay), studies found that hypoglycemia could still be associated with increased mortality risk (Leuven MICU study: OR 2.4 [P<0.001]) or it would disappear as an independent factor for mortality (Leuven SICU study: OR 1.9 [P=0.17]; and Leuven PICU study: OR 2.1 [P= 0.32]). Nested-case control studies, also correcting for on-admission risk factors and duration of ICU stay, could not demonstrate a causal link between hypoglycemia and mortality or increased serum levels of brain injury markers [42,43]. The latter study provided evidence that brain injury markers were already raised before the hypoglycemic event occurred, illustrating that baseline severity of illness is the chief contributor to the risk of hypoglycemia and elevated brain injury markers.…”

Section: Risk Of Hypoglycemiamentioning

confidence: 92%

Glycemic Targets and Approaches to Management of the Patient with Critical Illness

Mesotten

Berghe

2011

Curr Diab Rep

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Hyperglycemia during critical illness is associated with adverse outcome. The proof-of-concept Leuven studies assessed causality, and revealed that targeting strict normoglycemia (80-110 mg/dL) with insulin improved outcome compared with tolerating hyperglycemia to the renal threshold (215 mg/dL). A large multicenter trial (NICE-SUGAR [Normoglycaemia in Intensive Care Evaluation and Survival Using Glucose Algorithm Regulation]) found an intermediate blood glucose target (140-180 mg/dL) safer than targeting normoglycemia. Differences in design and in execution of glycemic control at the bedside may have contributed to these results. In NICE-SUGAR (Normoglycaemia in Intensive Care Evaluation and Survival Using Glucose Algorithm Regulation), the blood-glucose target range in the control group was lower, there were problems to reach and maintain normoglycemia in the intervention group, and inaccurate handheld blood glucose meters and variable blood sampling sites were allowed. Inaccurate tools led to insulin-dosing errors with consequently (undetected) hypoglycemia and unacceptable blood glucose variability. Also, the studies were done superimposed upon different nutritional strategies. Thus, such differences do not allow simple, evidence-based recommendations for daily practice, but an intermediate blood glucose target may be preferable while awaiting better tools to facilitate safely reaching normoglycemia.

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Section: Risk Of Hypoglycemiamentioning

confidence: 92%

Glycemic Targets and Approaches to Management of the Patient with Critical Illness

Mesotten

Berghe

2011

Curr Diab Rep

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“…Regarding the consequences of non-life-threatening hypoglycemia, long-term cognitive and other neurologic impairments were sometimes reported, but not in critically ill patients experiencing short-term hypoglycemic episodes [ 33 ]. These fi ndings do not necessarily imply that patients with longer-lasting hypoglycemia are not at risk.…”

Section: Risks and Hazards Of Hypoglycemiamentioning

confidence: 95%

Current status of tight blood sugar control

Preiser

Devos²

2008

Curr Infect Dis Rep

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This review describes the current status and the clinical data related to the effects of tight glucose control in critically ill patients. In contrast to decreases in mortality and morbidity reported in one study in which insulin rate was titrated to keep blood glucose between 80 and 110 mg/dL, the benefits were not confirmed in multicenter prospective studies. Retrospective data found an association between a mean blood glucose level below 140 to 150 mg/dL and improved outcome. Currently unanswered issues include the optimal target for blood glucose, effects of blood glucose variability, hazards of hypoglycemia, and potential influence of the underlying disorder on the effects of tight glucose control. Therefore, recommendations regarding practical aspects of tight glucose control by intensive insulin therapy cannot be supported by currently available data. An intermediate target level for blood glucose of 140 to 180 mg/dL seems associated with the lowest risk-to-benefit ratio.

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“…B. Bakteriämien, Nierenversagen und Poly neuropathien [27]. Die gefürchtete uner wünschte Nebenwirkung der IIT, die häu fig dem Umsetzen des Konzeptes in die Praxis entgegensteht, ist die Hypoglykä mie, obwohl es bei Intensivpatienten bis her keinen definitiven Nachweis gibt, dass eine kurzzeitige Hypoglykämie unter IIT eine attribuierbare neuropsychologische Dysfunktion oder Letalität verursacht [14,18,20,27,31].…”

Section: Hintergrundunclassified