Glucose control in the ICU

Gunst, Jan; Bruyn, Astrid De; Berghe, Greet Van den

doi:10.1097/aco.0000000000000706

Cited by 73 publications

(57 citation statements)

References 53 publications

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“…Hyperglycemia is associated with an adverse outcome and must be avoided. Tight glucose control is feasible in patients receiving parenteral nutrition if a strict protocol is followed [29].…”

Section: Glucosementioning

confidence: 99%

Nutrition in Sepsis: A Bench-to-Bedside Review

2020

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Nutrition therapy in sepsis is challenging and differs from the standard feeding approach in critically ill patients. The dysregulated host response caused by infection induces progressive physiologic alterations, which may limit metabolic capacity by impairing mitochondrial function. Hence, early artificial nutrition should be ramped-up and emphasis laid on the post-acute phase of critical illness. Caloric dosing is ideally guided by indirect calorimetry, and endogenous energy production should be considered. Proteins should initially be delivered at low volume and progressively increased to 1.3 g/kg/day following shock symptoms wane. Both the enteral and parenteral route can be (simultaneously) used to cover caloric and protein targets. Regarding pharmaconutrition, a low dose glutamine seems appropriate in patients receiving parenteral nutrition. Supplementing arginine or selenium is not recommended. High-dose vitamin C administration may offer substantial benefit, but actual evidence is too limited for advocating its routine use in sepsis. Omega-3 polyunsaturated fatty acids to modulate metabolic processes can be safely used, but non-inferiority to other intravenous lipid emulsions remains unproven in septic patients. Nutrition stewardship, defined as the whole of interventions to optimize nutritional approach and treatment, should be pursued in all septic patients but may be difficult to accomplish within a context of profoundly altered cellular metabolic processes and organ dysfunction caused by time-bound excessive inflammation and/or immune suppression. This review aims to provide an overview and practical recommendations of all aspects of nutritional therapy in the setting of sepsis.

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Section: Glucosementioning

confidence: 99%

Nutrition in Sepsis: A Bench-to-Bedside Review

2020

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“…Although the mechanism of damage caused by hyperglycemia to neonates is unknown, whether to give intervention is still controversial. Strict control of blood sugar with intensive insulin therapy (IIT) resulted in a 90-day increase in mortality despite a 28-day reduction in mortality [18][19][20]. Therefore, further studies are still needed for neonatal patients, and the bene ts and risks of blood glucose control are coexisted.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Factors on Low-Birth-Weight Infants of Atresia and/or Tracheoesophageal Fistula: a Cohort Study

Xu¹,

Ni²,

Li³

et al. 2020

Preprint

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Background: Low-birth-weight is the main factor affecting the survival rate of esophageal atresia (EA)/ tracheoesophageal fistula (TEF). The study aims to summarize the factors influencing the prognosis of EA/TEF, which is expected to be helpful for clinical diagnosis and treatment. Methods: A retrospective data analysis was performed in our hospital underwent TEF/EA repair between January 2012 and January 2015. The incidence of preoperative, intraoperative critical events and postoperative complications and overall survival (OS) were compared between two groups of infants: 81 patients with EA/TEF, 24 low-birth-weight patients (<2500 g) with EA/TEF and 57 patients (>2500 g). The morbidity was compared between patients with stress hyperglycemia and euglycemia postoperatively. Results: The overall incidence of preoperative, intraoperative critical events and postoperative complications in low-birth-weight patients was significantly higher (P=0.002, P=0.001, P=0.001), but OS was lower (75.9% vs 92.3%, p=0.027). OS of patients with stress hyperglycemia postoperatively was lower than that of euglycemia (81.0% vs 93.6%, p=0.03).Conclusions: Low-birth-weight still was the main factor that impacted on the prognosis of EA/TEF. The lower the birth weight was, the higher the mortality was. Postoperative stress hyperglycemia was one of the important factors that influenced survival rate.

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“…Greet Van den Berghe ve ark (15) , yapmış oldukları bir derlemede yoğun bakımlarda şeker kontrolü üzerine yapılan çalışmaları değerlendirmişler ve sıkı kan şekeri kontrolünün doğru bir izlem ve güvenilir bir insülin protokolü sağlandığında erken parenteral beslenme alan hastalarda güvenli ve etkili olduğunu bulmuşlardır. Her ne kadar kritik hastalar için optimal kan şekeri belirsiz olsa da; bu hasta grubunda şiddetli hiperglisemi ve hipoglisemi atakları ile kan şekeri değerlerindeki büyük değişimleri önlemenin daha ihtiyatlı ve güvenilir olacağını belirtmişlerdir.…”

Section: Discussionunclassified

Comparison of the Effects of Standard and Diabetesspecific Dietary Products on Tight Blood Glucose Control in Critically Ill Patients

Kızılaslan¹,

Ürkmez²,

Dikmen³

et al. 2020

tybd

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Nutritional support is a part of intensive care unit therapy. In our study, we investigated the effects of diabetes-specific enteral formula and standard enteral formula on tight blood glucose control and insulin requirement in hyperglycemic intensive care unit patients. Materials and Methods: The study was planned as a prospective, randomized, crossover comparative study. The daily caloric requirements for patients who tolerated enteral product intake were calculated as 25 kcal x body weight. Calorie requirements were divided into 21 hours and hourly calorie needs and nutrient volume were calculated. Eighty patients were divided into two groups. First group received ISOSOURCE® Standard and second group received Novasource® Diabetes in the first 24 hours. In the second 24 hours, Group 1 received Novasource® Diabetes, while Group 2 received Isosource® Standard. An intravenous insulin infusion was given to maintain the blood glucose level at 80-150 mg / dL. Blood glucose level was measured every 4 hours by taking arterial blood gas. Maximum, minimum, mean and median blood glucose levels, total insulin, mean insulin levels and the number of insulin dose changes were recorded. Results: No statistically significant difference was observed between two groups in terms of maximum, minimum and mean blood glucose levels. When compared, median blood glucose levels were numerically significant, but were not statistically significant in both groups. Conclusion: It was concluded that diabetes-specific enteral formula did not contribute significantly to tight blood glucose control in non-diabetic critical patients.

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Glucose control in the ICU

Cited by 73 publications

References 53 publications

Nutrition in Sepsis: A Bench-to-Bedside Review

Nutrition in Sepsis: A Bench-to-Bedside Review

Prognostic Factors on Low-Birth-Weight Infants of Atresia and/or Tracheoesophageal Fistula: a Cohort Study

Comparison of the Effects of Standard and Diabetesspecific Dietary Products on Tight Blood Glucose Control in Critically Ill Patients

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