CURRENT Essentials of Critical Care.pdf

12 Current Essentials of Critical Care■■Hyperglycemia, Management in the ICUEssential Concepts• Elevated blood glucose• Hyperglycemia affects fluid balance, possibly alters white bloodcell function, impairs complement activity• Increases mortality following stroke and myocardial infarction• Demonstrated benefits of tight glycemic control: decreasedwound infection following coronary artery bypass surgery; decreasedmortality in diabetics following myocardial infarction;decreased mortality, bacteremia, critical illness polyneuropathyin patients admitted to surgical ICU• Differential diagnosis: diabetes mellitus, laboratory error, stress,steroid induced diabetesEssentials of Management• Initiate intravenous infusion of insulin: titrate to goal blood glucoseof 80 to 120 mg/dL; use of insulin infusion protocol helpful• Consider switching to subcutaneous injections of long-acting insulinonce at stable regimen• Monitor for and attempt to avoid hypoglycemia■ PearlIntensive insulin therapy to treat hyperglycemia in critically ill patients,which may be due to illness related insulin resistance and notto previously known diabetes, appears to improve morbidity and mortality.ReferenceMontori VM et al: Hyperglycemia in acutely ill patients. JAMA2002;288:2167. [PMID: 12413377]