Moderate glycemic control safe in critically ill adult burn patients: A 15 year cohort study

Stoecklin, Patricia; Delodder, Frederik; Pantet, Olivier; Berger, Mette M.

doi:10.1016/j.burns.2015.10.025

Cited by 25 publications

(10 citation statements)

References 30 publications

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“…As the burns ICU is integrated in the medico-surgical 35-bed ICU structure of our hospital, moderate glucose control aiming at 6-8 mmol/L was also applied to the burns patients, who generally are fed by EN, and shown to be safe. 35…”

Section: Glucosementioning

confidence: 99%

“…The awareness about severe hyperglycemia being a killer led to blood glucose control using continuous insulin infusion to maintain blood glucose, at first with tight ranges of 4.1–6 mmol/L (73–108 mg/d) and, after much debate, with softer objectives of 6–8 mmol/L (108–144 mg/dL) 34 due to hypoglycemia having become an threatened complication. As the burns ICU is integrated in the medico‐surgical 35‐bed ICU structure of our hospital, moderate glucose control aiming at 6–8 mmol/L was also applied to the burns patients, who generally are fed by EN, and shown to be safe 35 …”

Section: Evolution Of Pn Solutionsmentioning

confidence: 99%

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Nutrition and Micronutrient Therapy in Critical Illness Should Be Individualized

Berger¹

2020

J Parenter Enteral Nutr

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Critically ill (intensive care unit [ICU]) patients are characterized by organ failure, intense inflammatory response, insulin resistance, and altered metabolic response. The sicker the patient, the higher the threat to nutrition and micronutrient status. In addition, many patients start the ICU stay with an altered nutrition status, which requires assessment upon admission. Nutrition needs vary among patients as well as during hospitalization, as the metabolic response changes over time. Shock and acute organ failure result in a metabolic shift toward intense catabolism: endogenous glucose production aiming at ensuring the basal adenosine triphosphate production starts immediately and occurs at the expense of the lean body mass using amino acids for neoglucogenesis. Later, the stabilization and recovery phases are characterized by higher energy and substrate needs. Indirect calorimetry is the only tool enabling determination of the metabolic level. When and how should feeding be started? Recent research shows that the route does not matter much, with equipoise between enteral and parenteral nutrition (PN) as long as overfeeding is avoided. As micronutrients are an integral part of metabolism and antioxidant defenses, their delivery must be ensured: whereas needs are well defined for healthy individuals, needs for illness remain poorly defined. PN that contains only macrosubstrates requires the daily prescription of multimicronutrient complements to qualify as total PN. Achievement of goals requires minimal monitoring, consisting of the daily verification of energy and protein goal delivery achievement and daily follow-up determining blood glucose and phosphate levels and insulin requirements.

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Section: Glucosementioning

confidence: 99%

Section: Evolution Of Pn Solutionsmentioning

confidence: 99%

Nutrition and Micronutrient Therapy in Critical Illness Should Be Individualized

Berger¹

2020

J Parenter Enteral Nutr

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“…Further large clinical trials are warranted to fully assess the efficacy and safety of these agents in the management of stress-induced diabetes in burn victims. Moreover, it has recently been reported that nurse-guided glucose control by insulin is a safe and efficacious means of preventing hyperglycemia in burned adults 79 , suggesting that there may not be a need to abandon insulin treatment in burn patients completely.…”

Section: The Pathophysiological Stress Response To Burn Traumamentioning

confidence: 99%

The metabolic stress response to burn trauma: current understanding and therapies

et al. 2016

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Summary Severe burns incur a profound stress response, which is unrivaled in terms of its magnitude and duration. Recent evidence suggests that the pathophysiological stress response to severe burns persists for several years post injury. Thus, there is a pressing need for novel strategies that mitigate this response and restore normal metabolic function in burn survivors. This is the first installment of a three-part series exploring the stress response to severe burn trauma. In this article we aim to distill the current knowledge pertaining to the stress response to burn trauma, highlighting recent developments and important knowledge gaps that need to be pursued in order to develop novel therapeutic strategies which improve outcomes in burn survivors.

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“…282 Its use is associated with hypoglycemia although this can be mitigated with target-guided protocols. 283 Metformin, exenatide, and fenofibrate have a role in control of hyperglycemic control beyond the acute stage of management and their use is discussed elsewhere. 14 Catecholamines drive the hypermetabolic response and can be suppressed by b-blockade.…”

Section: Perioperative Managementmentioning

confidence: 99%

A Critical Update of the Assessment and Acute Management of Patients with Severe Burns

Lang

Zhao²,

Kim

et al. 2019

Advances in Wound Care

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Burns are debilitating, life threatening, and difficult to assess and manage. Recent advances in assessment and management have occurred since a comprehensive review of the care of patients with severe burns was last published, which may influence research and clinical practice. Recent Advances: Recent advances have occurred in the understanding of burn pathophysiology, which has led to the identification of potential biomarkers of burn severity, such as protein C. There is new evidence about the potential superiority of natural colloids over crystalloids during fluid resuscitation, and new evidence about components of initial and perioperative management, including an improved understanding of pain following burns. Critical Issues: The limitations of the clinical examination highlight the need for imaging and biomarkers to assist in estimations of burn severity. Fluid resuscitation reduces mortality, although there is conjecture over the ideal method. The subsequent perioperative period is associated with significant morbidity and the evidence for preventing and treating pain, infection, and fluid overload while maximizing wound healing potential is described. Future Directions: Promising developments are ongoing in imaging technology, histopathology, biomarkers, and wound healing adjuncts such as hyperbaric oxygen therapy, topical negative pressure therapy, stem cell treatments, and skin substitutes. The greatest benefit from further research on management of patients with burns would most likely be derived from the elucidation of optimal fluid resuscitation protocols, pain management protocols, and surgical techniques from randomized controlled trials.

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Moderate glycemic control safe in critically ill adult burn patients: A 15 year cohort study

Cited by 25 publications

References 30 publications

Nutrition and Micronutrient Therapy in Critical Illness Should Be Individualized

Nutrition and Micronutrient Therapy in Critical Illness Should Be Individualized

The metabolic stress response to burn trauma: current understanding and therapies

A Critical Update of the Assessment and Acute Management of Patients with Severe Burns

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