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Intensive insulin therapy in the surgical intensive care unit

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https://www.readbyqxmd.com/read/27440134/thiamine-levels-during-intensive-insulin-therapy-in-critically-ill-patients
#1
Wouter van Snippenburg, Mariet G J Reijnders, Jose G M Hofhuis, Rien de Vos, Stephan Kamphuis, Peter E Spronk
INTRODUCTION: Thiamine is an essential cofactor in carbohydrate metabolism, and deficiency can therefore cause various organ dysfunctions. Little is known about the prevalence and possible worsening of thiamine deficiency in critically ill patients. In this study, we investigated the prevalence of thiamine deficiency at admission to the intensive care unit (ICU) and hypothesized that intensive insulin therapy, aimed at regulating glucose levels, increases thiamine utilization and therefore might cause or worsen deficiency in patients with limited thiamine stores...
July 20, 2016: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/26952114/major-cardiac-events-after-non-cardiac-surgery
#2
Gabriela Sousa, Ana Lopes, Pedro Reis, Vasco Carvalho, Alice Santos, Fernando José Abelha
INTRODUCTION: Postoperative cardiovascular complications might be difficult to assess and are known to be associated with longer hospital stay and increased costs as well as higher morbidity and mortality rates. The aim of this study was to evaluate the predictors for major cardiac events (MCE) after non-cardiac surgery. METHODS: The study included 4398 patients who were admitted to the Surgical Intensive Care Unit between January 1, 2006 and July 19, 2013. Acute physiology and chronic health evaluation II score and simplified acute physiology score (SAPS II) were calculated, and all variables entered as parameters were evaluated independently...
August 2016: World Journal of Surgery
https://www.readbyqxmd.com/read/26908569/transition-from-intravenous-to-subcutaneous-insulin-in-critically-ill-adults
#3
Meagan K Doolin, Todd A Walroth, Serena A Harris, Jessica A Whitten, Andrew C Fritschle-Hilliard
BACKGROUND: Glycemic control decreases morbidity and mortality in critically ill patients. However, limited guidance exists regarding the transition from intravenous (IV) to subcutaneous insulin therapy. A validated protocol for transition is necessary since glycemic variability, hyperglycemia, and hypoglycemia adversely impact patient outcomes. METHOD: The objective was to determine the safest and most effective method to transition critically ill adults from IV to subcutaneous insulin...
July 2016: Journal of Diabetes Science and Technology
https://www.readbyqxmd.com/read/26879684/the-diabetes-remission-clinical-trial-direct-protocol-for-a-cluster-randomised-trial
#4
Wilma S Leslie, Ian Ford, Naveed Sattar, Kieren G Hollingsworth, Ashley Adamson, Falko F Sniehotta, Louise McCombie, Naomi Brosnahan, Hazel Ross, John C Mathers, Carl Peters, George Thom, Alison Barnes, Sharon Kean, Yvonne McIlvenna, Angela Rodrigues, Lucia Rehackova, Sviatlana Zhyzhneuskaya, Roy Taylor, Mike E J Lean
BACKGROUND: Despite improving evidence-based practice following clinical guidelines to optimise drug therapy, Type 2 diabetes (T2DM) still exerts a devastating toll from vascular complications and premature death. Biochemical remission of T2DM has been demonstrated with weight loss around 15kg following bariatric surgery and in several small studies of non-surgical energy-restriction treatments. The non-surgical Counterweight-Plus programme, running in Primary Care where obesity and T2DM are routinely managed, produces >15 kg weight loss in 33% of all enrolled patients...
February 16, 2016: BMC Family Practice
https://www.readbyqxmd.com/read/26357785/attenuating-the-systemic-inflammatory-response-to-adult-cardiopulmonary-bypass-a-critical-review-of-the-evidence-base
#5
REVIEW
R Clive Landis, Jeremiah R Brown, David Fitzgerald, Donald S Likosky, Linda Shore-Lesserson, Robert A Baker, John W Hammon
A wide range of pharmacological, surgical, and mechanical pump approaches have been studied to attenuate the systemic inflammatory response to cardiopulmonary bypass, yet no systematically based review exists to cover the scope of anti-inflammatory interventions deployed. We therefore conducted an evidence-based review to capture "self-identified" anti-inflammatory interventions among adult cardiopulmonary bypass procedures. To be included, trials had to measure at least one inflammatory mediator and one clinical outcome, specified in the "Outcomes 2010" consensus statement...
September 2014: Journal of Extra-corporeal Technology
https://www.readbyqxmd.com/read/26219520/metabolic-uncoupling-following-cardiopulmonary-bypass
#6
Robert A Palermo, Hannah L Palac, Eric L Wald, Mark S Wainwright, John M Costello, Osama M Eltayeb, Carl L Backer, Conrad L Epting
OBJECTIVE: The objective of this study was to characterize the natural history of metabolic uncoupling (type B hyperlactemia and hyperglycemia) following cardiopulmonary bypass (CPB), and to determine the impact of insulin therapy on time to lactate normalization in patients without low cardiac output. DESIGN: The design used was a retrospective cohort study. SETTING: The study was set in a pediatric cardiac intensive care unit in a tertiary-care urban children's hospital...
November 2015: Congenital Heart Disease
https://www.readbyqxmd.com/read/26079777/perioperative-tight-glucose-control-reduces-postoperative-adverse-events-in-nondiabetic-cardiac-surgery-patients
#7
RANDOMIZED CONTROLLED TRIAL
Jan Bláha, Miloš Mráz, Petr Kopecký, Martin Stříteský, Michal Lipš, Michal Matias, Jan Kunstýř, Michal Pořízka, Tomáš Kotulák, Ivana Kolníková, Barbara Šimanovská, Mykhaylo Zakharchenko, Jan Rulíšek, Robert Šachl, Jiří Anýž, Daniel Novák, Jaroslav Lindner, Roman Hovorka, Štěpán Svačina, Martin Haluzík
CONTEXT: Tight glucose control (TGC) reduces morbidity and mortality in patients undergoing elective cardiac surgery, but only limited data about its optimal timing are available to date. OBJECTIVE: The purpose of this article was to compare the effects of perioperative vs postoperative initiation of TGC on postoperative adverse events in cardiac surgery patients. DESIGN: This was a single center, single-blind, parallel-group, randomized controlled trial...
August 2015: Journal of Clinical Endocrinology and Metabolism
https://www.readbyqxmd.com/read/26075854/-what-may-cause-diabetes
#8
Miroslav Pernický, Juraj Papinčák, Adriana Reptová, Soňa Kiňová, Ján Murín
UNLABELLED: The case study describes a case of 49-year-old man with morbid obesity since childhood (BMI 40 kg/m2), arterial hypertension (approx. since aged 15, treated since 2004), dyslipidemia (since 2006), type 2 diabetes mellitus (since 2006, on insulin therapy since 2008) and smoking (until 2011, 20 cigarettes a day). TREATMENT: 16 types of medication, 8 for hypertension, statin, therapy for diabetes, aspirin, allopurinol. In 2010 (when aged 45) hospitalized in our clinic with dyspnoea and chest pain with a high pressure reading of 180/110 mm Hg (identified symptoms of heart failure with LV ejection fraction of 33 %, in NYHA II functional class, echocardiographically: left atrium: 46 mm, left ventricular chamber size in diastole: 70 mm, interventricular septum: 12 mm, septal hypokinesis, Doppler ultrasonography of lower limb arteries (calcification, diffuse atherosclerotic changes, absent stenosis), CT coronary angiography (significant stenosis of the left coronary artery)...
May 2015: Vnitr̆ní Lékar̆ství
https://www.readbyqxmd.com/read/25927986/time-in-blood-glucose-range-70-to-140-mg-dl-80-is-strongly-associated-with-increased-survival-in-non-diabetic-critically-ill-adults
#9
James S Krinsley, Jean-Charles Preiser
INTRODUCTION: Hyperglycemia, hypoglycemia and increased glucose variability are independently associated with increased risk of death in critically ill adults. The relationship between time in targeted blood glucose range (TIR) and mortality is not well described and may be a factor that has confounded the results of the major interventional trials of intensive insulin therapy. METHODS: We conducted a retrospective analysis of prospectively collected data involving 3,297 patients with intensive care unit (ICU) lengths of stay (LOS) of ≥ 1...
2015: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/25668933/consensus-recommendations-for-the-management-of-hyperglycaemia-in-critically-ill-patients-in-the-indian-setting
#10
REVIEW
J J Mukherjee, P S Chatterjee, M Saikia, A Muruganathan, Ashok Kumar Das
Hyperglycaemia occurs frequently in critically-ill patients. Not only does it occur among patients with pre-existing diabetes mellitus but elevated blood glucose values during an acute illness can also be seen in previously glucose-tolerant individuals (stress hyperglycaemia). Numerous observational studies have shown an increase in morbidity and mortality in critically ill patients with hyperglycaemia. Interestingly, outcomes in individuals with stress hyperglycaemia are worse than that in critically ill hyperglycaemic patients with pre-existing diabetes...
July 2014: Journal of the Association of Physicians of India
https://www.readbyqxmd.com/read/25189764/effects-of-tight-computerized-glucose-control-on-neurological-outcome-in-severely-brain-injured-patients-a-multicenter-sub-group-analysis-of-the-randomized-controlled-open-label-cgao-rea-study
#11
RANDOMIZED CONTROLLED TRIAL
Raphaël Cinotti, Carole Ichai, Jean-Christophe Orban, Pierre Kalfon, Fanny Feuillet, Antoine Roquilly, Bruno Riou, Yvonnick Blanloeil, Karim Asehnoune, Bertrand Rozec
INTRODUCTION: Hyperglycemia is a marker of poor prognosis in severe brain injuries. There is currently little data regarding the effects of intensive insulin therapy (IIT) on neurological recovery. METHODS: A sub-group analysis of the randomized-controlled CGAO-REA study (NCT01002482) in surgical intensive care units (ICU) of two university hospitals. Patients with severe brain injury, with an expected ICU length of stay ≥ 48 hours were included. Patients were randomized between a conventional glucose management group (blood glucose target between 5...
2014: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/25172875/reducing-the-risk-of-hypoglycemia-associated-with-intravenous-insulin-experience-with-a-computerized-insulin-infusion-program-in-4-adult-intensive-care-units
#12
Victoria Sandler, Meaghan R Misiasz, Jocelyn Jones, David Baldwin
Computerized insulin infusion protocols have facilitated more effective blood glucose (BG) control in intensive care units (ICUs). This is particularly important in light of the risks associated with hypoglycemia. End stage renal disease (ESRD) increases the risk of insulin-induced hypoglycemia. We evaluated BG control in 210 patients in 2 medical ICUs and in 2 surgical ICUs who were treated with a computerized insulin infusion program (CIIP). Our CIIP was programmed for a BG target of 140-180 mg/dL for medical ICU patients or 120-160 mg/dL for surgical ICU patients...
September 2014: Journal of Diabetes Science and Technology
https://www.readbyqxmd.com/read/24687353/acute-kidney-injury-in-cardiac-surgery
#13
Bernardo Moguel-González, Michael Wasung-de-Lay, Pamela Tella-Vega, Constanza Riquelme-Mc-Loughlin, Antonio R Villa, Magdalena Madero, Gerardo Gamba
INTRODUCTION: Acute kidney injury (AKI) associated with cardiac surgery is a common postoperative complication that increases the morbidity and mortality substantially. However, there is limited information of AKI after cardiac surgery in our institution. MATERIAL AND METHODS: We conducted a prospective, observational, and longitudinal analysis of adult patients that underwent to cardiac surgery requiring cardiopulmonary bypass and aortic cross clamp. Patients with preoperative chronic renal insufficiency that were on dialysis, with AKI detected up to 24 h before the procedure, or that received contrast agents 72 h before surgery were excluded...
November 2013: Revista de Investigación Clínica; Organo del Hospital de Enfermedades de la Nutrición
https://www.readbyqxmd.com/read/24623024/intensive-versus-intermediate-glucose-control-in-surgical-intensive-care-unit-patients
#14
RANDOMIZED CONTROLLED TRIAL
Takehiro Okabayashi, Yasuo Shima, Tatsuaki Sumiyoshi, Akihito Kozuki, Teppei Tokumaru, Tasuo Iiyama, Takeki Sugimoto, Michiya Kobayashi, Masataka Yokoyama, Kazuhiro Hanazaki
OBJECTIVE: The optimal perioperative blood glucose range to improve surgical site infection (SSI) in surgical intensive care unit (ICU) patients remains unclear. We sought to determine whether the incidence of SSI is reduced by perioperative intensive insulin therapy (IT). RESEARCH DESIGN AND METHODS: Patients were randomly assigned to receive perioperative intensive IT, with a target blood glucose range of 4.4-6.1 mmol/L, or intermediate IT, with a target blood glucose range of 7...
June 2014: Diabetes Care
https://www.readbyqxmd.com/read/24553551/continuous-glucose-monitoring-in-the-surgical-intensive-care-unit-concordance-with-capillary-glucose
#15
Kevin M Schuster, Kimberly Barre, Silvio E Inzucchi, Robert Udelsman, Kimberly A Davis
BACKGROUND: The role of intensive glycemic control (IGC) in the surgical intensive care unit (SICU) remains controversial. Continuous glucose monitoring systems (CGMSs) may mitigate the major risk of IGC, namely hypoglycemia, and improve clinical outcomes. METHODS: All patients admitted to the SICU requiring insulin infusion were eligible. CGMS (Medtronic Guardian REAL-Time CGM, Northridge, CA) was placed in the subcutaneous tissue of the abdomen or thigh and calibrated every 8 hours, based on capillary (fingerstick) blood glucose (CBG) readings...
March 2014: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/24477672/interventions-for-preventing-critical-illness-polyneuropathy-and-critical-illness-myopathy
#16
REVIEW
Greet Hermans, Bernard De Jonghe, Frans Bruyninckx, Greet Van den Berghe
BACKGROUND: Critical illness polyneuropathy or myopathy (CIP/CIM) is a frequent complication in the intensive care unit (ICU) and is associated with prolonged mechanical ventilation, longer ICU stay and increased mortality. This is an interim update of a review first published in 2009 (Hermans 2009). It has been updated to October 2011, with further potentially eligible studies from a December 2013 search characterised as awaiting assessment. OBJECTIVES: To systematically review the evidence from RCTs concerning the ability of any intervention to reduce the incidence of CIP or CIM in critically ill individuals...
January 30, 2014: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/24378668/are-closed-loop-systems-for-intensive-insulin-therapy-ready-for-prime-time-in-the-icu
#17
REVIEW
Takehiro Okabayashi, Yasuo Shima
PURPOSE OF REVIEW: Recent findings suggest that the effects of tight glycemic control (TGC) performing intensive insulin therapy (IIT) in medical and surgical ICU have had conflicting results. The purpose of this review is to summarize the current evidence in humans how closed-loop systems for IIT are ready for prime time in the ICU. RECENT FINDINGS: Current evidence suggests that maintaining normoglycemia postoperatively can improve the outcome and reduce the mortality and morbidity of critically ill patients by TGC performing IIT according to the large randomized trials...
March 2014: Current Opinion in Clinical Nutrition and Metabolic Care
https://www.readbyqxmd.com/read/24372028/hypoglycaemia-and-predisposing-factors-among-clinical-subgroups-treated-with-intensive-insulin-therapy
#18
R M Waeschle, A Bräuer, R Hilgers, P Herrmann, P Neumann, M Quintel, O Moerer
BACKGROUND: In previous studies, conflicting intensive insulin therapy (IIT) results have been observed, whereby IIT-related mortality seems to be lower in specific clinical subgroups. The aim of this study was to assess differences in glycaemic control, the risk of critical hypoglycaemia (≤ 2.2 mmol/l), the associated predisposing factors, and the in-hospital mortality in different clinical subgroups treated with IIT. METHODS: Prospective, observational study in a university-affiliated intensive care unit (ICU) conducted from 2004 to 2005...
February 2014: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/24247476/the-glucoregulatory-benefits-of-glucagon-like-peptide-1-7-36-amide-infusion-during-intensive-insulin-therapy-in-critically-ill-surgical-patients-a-pilot-study
#19
RANDOMIZED CONTROLLED TRIAL
Panagis Galiatsatos, B Robert Gibson, Atoosa Rabiee, Olga Carlson, Josephine M Egan, Richard P Shannon, Dana K Andersen, Dariush Elahi
OBJECTIVES: Intensive insulin therapy for tight glycemic control in critically ill surgical patients has been shown to reduce mortality; however, intensive insulin therapy is associated with iatrogenic hypoglycemia and increased variability of blood glucose levels. The incretin glucagon-like peptide-1 (7-36) amide is both insulinotropic and insulinomimetic and has been suggested as an adjunct to improve glycemic control in critically ill patients. We hypothesized that the addition of continuous infusion of glucagon-like peptide-1 to intensive insulin therapy would result in better glucose control, reduced requirement of exogenous insulin administration, and fewer hypoglycemic events...
March 2014: Critical Care Medicine
https://www.readbyqxmd.com/read/24160207/-management-of-parenteral-nutrition-in-intensive-care-units-in-spain
#20
MULTICENTER STUDY
Clara Vaquerizo Alonso, Alfonso Mesejo, José Acosta Escribano, Sergio Ruiz Santana
INTRODUCTION AND OBJECTIVES: some relevant aspects related to parenteral nutrition in the Spanish ICUs are still unclear. These aspects include: caloric and protein intake, total volume, glycemic control, the type of lipid emulsion used or the comparison of different formulations. Our objective is to know the clinical practice patterns of artificial nutrition therapeutics, particularly of parenteral nutrition in the Spanish ICUs. MATERIAL AND METHODS: twelve representative ICU's participated in a nutrition survey from January to March 2012...
September 2013: Nutrición Hospitalaria: Organo Oficial de la Sociedad Española de Nutrición Parenteral y Enteral
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