Glycemic control in critically ill patients

Abstract

Stress hyperglycemia is commonly found in critically ill patients. Although the exact pathogenesis of the raised of blood sugar remains unclear, many clinicians believe that the combination of increased gluconeogenesis, glycogenolysis and insulin resistance may play a role. Also, an exact definition of stress hyperglycemia has not been established. However, stress hyperglycemia associated with the worst intensive care and hospital treatment outcomes has been reported in many clinical studies. Previously, many clinicians had commenced glycemic control when blood sugar rose above 200 mg/dl. This level of blood sugar had been accepted for commencing of glycemic control for years to avoid a medical complication that would otherwise occur, particularly in the postoperative period. Nevertheless, the method of glycemic control remained controversial. Recently, intensive glycemic control has resulted in better outcome in critical care settings, even though the level of glycemic control was not consistent between studies. All studies have applied the intensive insulin infusion protocol for continuously controlling blood glucose not only in postoperative patients but also in medically ill patients. This review will discuss the pathogenesis of stress hyperglycemia, the impact of hyperglycemia in critical care settings and methods of glycemic control based on current clinical studies.

Keywords

• stress hyperglycemia
• hyperglycemia
• intensive insulin treatment
• glycemic control
• critically ill