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blood glucose control in ICU

Peter J Watkinson, Vicki S Barber, J Duncan Young
BACKGROUND: Observational and interventional studies in patients with both acute medical conditions and long-standing diabetes have shown that improved blood glucose control confers a survival advantage or reduces complication rates. Policies of "tight" glycaemic control were rapidly adopted by many general intensive care units (ICUs) worldwide in the mid 00's, even though the results of the studies were not generalizable to mixed medical/surgical ICUs with different intravenous feeding policies...
March 8, 2018: JMIR Research Protocols
Nora Luethi, Luca Cioccari, Peter Biesenbach, Luca Lucchetta, Hidetoshi Kagaya, Rhys Morgan, Francesca Di Muzio, Barbara Presello, Duaa Gaafar, Alison Hay, Marco Crisman, Roisin Toohey, Hollie Russell, Neil J Glassford, Glenn M Eastwood, Elif I Ekinci, Adam M Deane, Rinaldo Bellomo, Johan Mårtensson
OBJECTIVES: To assess the feasibility, biochemical efficacy, and safety of liberal versus conventional glucose control in ICU patients with diabetes. DESIGN: Prospective, open-label, sequential period study. SETTING: A 22-bed mixed ICU of a tertiary hospital in Australia. PATIENTS: We compared 350 consecutive patients with diabetes admitted over 15 months who received liberal glucose control with a preintervention control population of 350 consecutive patients with diabetes who received conventional glucose control...
March 3, 2018: Critical Care Medicine
Jacqueline M Gordon, Lori S Lauver, Harleah G Buck
BACKGROUND: Hyperglycemia post-cardiac surgery is associated with poor clinical outcomes. Recent studies suggest maintaining liberal glycemic control (<180mg/dL) using a continuous insulin infusion (CII) versus strict control achieves optimal outcomes and prevents hypoglycemia. PURPOSE: To develop, implement and evaluate a nurse managed liberal CII protocol. METHODS: Retrospective review of 144 strict CII patient records and 147 liberal CII patient records...
February 2018: Applied Nursing Research: ANR
Zhongliang Yang, Guoqiang Tao, Meifeng Guo, Baoling Sun, Liang Gong, Yong Ding, Shuming Ye, Weidong Liu, Xiuyun Yang
OBJECTIVE: To explore efficacy and safety of simulated artificial pancreas in modulating stress hyperglycemia in critically ill patients. METHODS: A prospective randomized controlled study was performed. Seventy-two critically ill patients with stress hyperglycemia, aged 18-85 years, acute physiology and chronic health evaluation II (APACHE II) score over 15, two consecutive random blood glucose 11.1 mmol/L or higher, glycated hemoglobin (HbA1C) below 0.065, unable to eat food for 3 days after inclusion, or only accepting parenteral nutrition, admitted to intensive care unit (ICU) in Shanghai Punan Hospital of Pudong New District from January 1st, 2015 to June 30th, 2017 were enrolled...
February 2018: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Natsuhiro Yamamoto, Tomoya Irie, Shunsuke Takaki, Osamu Yamaguchi, Takahisa Goto
PURPOSE: Hyperglycemia is a common issue in infants after cardiac surgery for congenital heart disease. Poor glycemic control is suspected to be associated with adverse postoperative outcomes. This study was performed to investigate clinical factors contributing to hyperglycemia in the perioperative period in infats. METHODS: A total of 69 infants (aged 1-12 months) who were admitted to Yokohama City University Hospital Intensive Care Unit (ICU) after surgical repair of congenital heart diseases with cardiopulmonary bypass (CPB) were retrospectively analysed...
January 12, 2018: Journal of Anesthesia
Ömer Faruk Şavluk, Mehmet Ali Kuşçu, Füsun Güzelmeriç, Mustafa Emre Gürcü, Atakan Erkılınç, Deniz Çevirme, Halide Oğuş, Tuncer Koçak
Background/aim: The aim of this prospective study was to determine whether the preoperative oral intake of carbohydrate-rich drinks by patients undergoing a coronary artery bypass graft attenuates postoperative insulin requirements, improves postoperative patient discomfort, provides inotropic support, shortens the length of the ICU stay, and shortens the duration of postoperative mechanical ventilation. Materials and methods: This randomized prospective clinical study included 152 patients with coronary artery disease who were divided into 4 groups...
December 19, 2017: Turkish Journal of Medical Sciences
Amra Sakusic, John C O'Horo, Mikhail Dziadzko, Dziadzko Volha, Rashid Ali, Tarun D Singh, Rahul Kashyap, Ann M Farrell, John D Fryer, Ronald Petersen, Ognjen Gajic, Alejandro A Rabinstein
Long-term cognitive impairment is common in survivors of critical illness. Little is known about the etiology of this serious complication. We sought to summarize current scientific knowledge about potentially modifiable risk factors during intensive care unit (ICU) treatment that may play a substantial role in the development of long-term cognitive impairment. All searches were run on October 1, 2017. The search strategy included Ovid MEDLINE, Ovid Embase, Ovid CDR, Cochrane Central Register of Controlled Trials and Database of Abstracts of Reviews of Effect, Scopus, and Web of Science, and included MeSH headings and keywords related to intensive care, critical care, and cognitive disorders...
January 2018: Mayo Clinic Proceedings
Gianni Biolo, Benedetta Massolino, Filippo Giorgio Di Girolamo, Nicola Fiotti, Filippo Mearelli, Sara Mazzucco, Carlos Bertuzzi, Renzo Lazzarini, Alfonso Colombatti, Marcello De Cicco
OBJECTIVE: The glutathione system plays an essential role in antioxidant defense after surgery. We assessed the effects of intensive insulin treatment (IIT) on glutathione synthesis rate and redox balance in cancer patients, who had developed stress hyperglycemia after major surgery. METHODS: We evaluated 10 non-diabetic cancer patients the day after radical abdominal surgery combined with intra-operative radiation therapy. In each patient, a 24-hr period of IIT, aimed at tight euglycemic control, was preceded, or followed, by a 24-hr period of conventional insulin treatment (CIT) (control regimen)...
2018: PloS One
Quyen N Bach, Rod A Gilmore, Melody C Sheffield, W Anthony Hawkins
Background: Routine administration of correctional insulin is no longer recommended as a primary strategy to treat hyperglycemia in hospitalized patients. Studies have demonstrated significant improvement in glycemic control in patients treated with basal and correctional insulin (B+C) versus correctional insulin alone (C). However, the effect of C or B+C on hypoglycemic events is not well understood. Objective: The objective of this study was to investigate the effect of B+C versus C on hypoglycemic events in hospitalized elderly patients...
December 2017: Hospital Pharmacy
Marina Rabinovich, Jessica Grahl, Emily Durr, Rita Gayed, Katleen Chester, Raymie McFarland, Barbara McLean
BACKGROUND: Insulin infusions are commonly utilized to control hyperglycemia in critically ill patients and decrease hyperglycemia associated complications. Safety concerns have been raised in trials evaluating methods of glycemic control regarding the incidence of hypoglycemia and its relationship to increased mortality. Electronic glycemic management systems (eGMS) may result in less variable blood glucose (BG) control and less hypoglycemia. This study aimed to compare BG control, time in target BG range, and the rate of hypoglycemia when critically ill patients were managed with an insulin infusion guided by paper-based protocol (PBP) versus eGMS...
December 1, 2017: Journal of Diabetes Science and Technology
Minkyung Kim, Minjoo Kim, Hana Jeong, Jey Sook Chae, Young Sam Kim, Jae Gil Lee, Younsoo Cho, Jong Ho Lee
BACKGROUND: To investigate natural killer (NK) cell activity, circulating cytokine level and peripheral blood mononuclear cell (PBMC) cytokine production status in critically ill patients. METHODS: Blood samples were collected <24 h after admission from 24 intensive care unit (ICU) patients and 24 age-, sex-, and body mass index (BMI)-matched healthy controls. Serum cytokine concentrations and cytokine production by PBMCs and lipopolysaccharide (LPS)-stimulated PBMCs were measured...
December 8, 2017: BMC Immunology
Chunmiao Zhong, Chaohui Ji, Zhuquan Dai, Kai Fu, Xiaohong Wen, Huibin Pan
OBJECTIVE: To study the effect of early entreat nutrition (EN) standardized treatment on optimization of blood glucose control and prognosis in acute respiratory distress syndrome (ARDS) patients with mechanical ventilation (MV). METHODS: Forty-two patients with MV of ARDS admitted to Huzhou First Municipal People's Hospital from April 2015 to March 2017 were enrolled. April 1st, 2016 was taken as the time node, the patients treated from April 1st, 2015 to March 31st, 2016 were assigned in the control group (n = 20), while the patients treated from April 1st, 2016 to March 31st, 2017 were included in the experimental group (n = 22)...
December 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Keren Zhou, Mia F Williams, Mary Angelynne Esquivel, Anne Song, Farah Rahman, James Bena, Simon W Lam, Deborah A Rathz, M Cecilia Lansang
BACKGROUND: There is a paucity of studies on transitions from IV insulin infusion (IVII) to subcutaneous (SC) insulin in the medical ICU (MICU). METHODS: We conducted a retrospective study of patients admitted to the Cleveland Clinic MICU from June 2013 to January 2014 who received IVII. We compared blood glucose (BG) control between 3 cohorts based on timing of basal insulin dose: (1) NB (no basal), (2) IB (incorrect basal), (3) CB (correct basal) at 5 time points post-IVII discontinuation (1, 4, 8, 12, and 24h)...
December 2017: Diabetes Research and Clinical Practice
Jianting Gao, Qiuyan Wang
OBJECTIVE: To observe the impact of initial low-dose (trophic type) enteral nutrition (EN) support on mechanical ventilation (MV) time, the incidence of complications and survival rate in patients with acute respiratory failure (ARF). METHODS: A prospective study was conducted. Forty-four patients with ARF undergoing MV admitted to Department of Critical Care Medicine of Hangzhou Traditional Chinese Medical Hospital from September 2015 to February 2017 were enrolled, and they were divided into a trophic feeding group (n = 23, study group) and a standard-dose feeding group (n = 21, control group)...
November 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Qiongyuan Hu, Jian'an Ren, Wenhao Tang, Jieshou Li
OBJECTIVE: To investigate the effect of hyperglycemia within postoperative 48 hours on gastrointestinal (GI) fistula patients without preoperative diagnosis of diabetes undergoing selective GI reconstruction. METHODS: Clinical data of GI fistula patients with age of 18 to 70 years and without diffuse peritonitis and systemic infection undergoing definitive GI reconstruction at Intestinal Fistula Center of Jinling Hospital from September 2012 to December 2015 were retrospectively analyzed...
October 25, 2017: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
Tony Zhou, Jennifer L Dickson, Geoffrey M Shaw, J Geoffrey Chase
BACKGROUND: Continuous glucose monitoring (CGM) technology has become more prevalent in the intensive care unit (ICU), offering potential benefits of increased safety and reduced workload in glycemic control (GC). The drift and higher point accuracy errors of CGM devices over traditional intermittent blood glucose (BG) measures have so far limited their application in the ICU. This study delineates the trade-offs of performance, safety and workload that CGM sensors provide in GC protocols...
November 1, 2017: Journal of Diabetes Science and Technology
Z K Yu, Z J Gong, X D Jian, A J Qu
Objective: To observe the therapeutic efficacy of alanyl glutamine injection on patients with gastrointestinal function obstacle caused by severe phorate poisoning. Methods: A total of 80 eligible patients with gastrointestinal function obstacle caused by severe phorate poisoning were randomly divided into the control group (n=40) and treatment group (n=40) . The control group was treated with the conventional therapy, which included forbidden diet, atropine, pralidoxime iodide, anti-inflammatory, albumin infusion, ω-3 fish oil fat emulsion, protection of organs function, blood perfusion, and Fat Emulsion, Amino Acids (17) and Glucose Injection...
July 20, 2017: Chinese Journal of Industrial Hygiene and Occupational Diseases
Faisal Jehan, Muhammad Khan, Joseph V Sakran, Mohammad Khreiss, Terence O'Keeffe, Albert Chi, Narong Kulvatunyou, Arpana Jain, El Rasheid Zakaria, Bellal Joseph
BACKGROUND: Plasma hemoglobin A1c (HbA1c) reflects quality of glucose control in diabetic patients. Literature reports that patients undergoing surgery with an elevated HbA1c level are associated with increased postoperative morbidity and mortality. The aim of our study was to evaluate the impact of HbA1c level on outcomes after emergency general surgery (EGS). METHODS: We performed a 3-year analysis of our prospectively maintained EGS database. Patients who had HbA1c levels measured within 3 months before surgery were included...
January 2018: Journal of Trauma and Acute Care Surgery
Vishesh Verma, Narendra Kotwal, Vimal Upreti, Monish Nakra, Yashpal Singh, K Anand Shankar, Amit Nachankar, K V S Hari Kumar
BACKGROUND: Intravenous insulin is the cornerstone in the management of hyperglycemia in the Intensive Care Unit (ICU). We studied the efficacy of liraglutide compared with insulin in the ICU. MATERIALS AND METHODS: In this prospective, open-labeled, randomized study, we included 120 patients (15-65 years, either sex) admitted to ICU with capillary blood glucose (CBG) between 181 and 300 mg/dl. We excluded patients with secondary diabetes and APACHE score >24...
September 2017: Indian Journal of Critical Care Medicine
James Stephen Krinsley
Hyperglycemia is very common in critically ill patients and interventional studies of intensive insulin therapy with the goal of returning ICU glycemia to normal levels have demonstrated mixed results. A large body of literature has demonstrated that diabetes, per se, is not independently associated with increased risk of mortality in this population and that the relationship of glucose metrics to mortality is different for patients with and without diabetes. Moreover, these relationships are confounded by preadmission glycemia; in this regard, patients with diabetes and good preadmission glucose control, as reflected by HbA1c levels obtained at the time of ICU admission, are similar to patients without diabetes...
September 1, 2017: Journal of Diabetes Science and Technology
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