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blood glucose control in ICU

Cláudia Righy Shinotsuka, Alexandre Brasseur, David Fagnoul, Timothy So, Jean-Louis Vincent, Jean-Charles Preiser
BACKGROUND: Intravascular continuous glucose monitoring (CGM) may facilitate glycemic control in the intensive care unit (ICU). We compared the accuracy of a CGM device (OptiScanner®) with a standard reference method. METHODS: Adult patients who had blood glucose (BG) levels >150 mg/dl and required insertion of an arterial and central venous catheter were included. The OptiScanner® was inserted into a multiple-lumen central venous catheter. Patients were treated using a dynamic-scale insulin algorithm to achieve BG values between 80 and 150 mg/dl...
November 25, 2016: Critical Care: the Official Journal of the Critical Care Forum
Kirsten S Deemer, George F Alvarez
Mauriac syndrome is a rare disorder that can present with the single feature of glycogenic hepatopathy in children and adults with poorly controlled diabetes mellitus. An often underrecognized finding of glycogenic hepatopathy is lactic acidosis and hyperlactatemia. Primary treatment of glycogenic hepatopathy is improved long-term blood glucose control. Resolution of symptoms and hepatomegaly will occur with improvement in hemoglobin A1C. We present here a case of a young adult female presenting to the intensive care unit with Mauriac syndrome...
2016: Case Reports in Critical Care
Tomohide Yamada, Nobuhiro Shojima, Hisashi Noma, Toshimasa Yamauchi, Takashi Kadowaki
PURPOSE: It is unclear whether tight glycemic control is warranted in all critically ill adults. We employed network meta-analysis to examine the risk of mortality and hypoglycemia associated with different glycemic control targets in critically ill adults. METHODS: Electronic databases were searched up to 2016 for randomized controlled trials comparing various insulin regimens in critically ill adults with hyperglycemia. Two reviewers independently extracted information and evaluated quality with the Cochrane risk-of-bias tool...
September 16, 2016: Intensive Care Medicine
Nora Luethi, Luca Cioccari, Marco Crisman, Rinaldo Bellomo, Glenn M Eastwood, Johan Mårtensson
BACKGROUND: It is uncertain whether liberal glucose control in critically ill diabetic patients leads to increased ketone production and ketoacidosis. Therefore, we aimed to assess the prevalence of ketosis, ketonuria and ketoacidosis in critically ill diabetic patients treated in accordance with a liberal glycemic control protocol. METHODS: We performed a prospective observational cohort study of 60 critically ill diabetic patients with blood and/or urine ketone bodies tested in ICU...
September 15, 2016: Critical Care: the Official Journal of the Critical Care Forum
Lily E Johnston, Jennifer L Kirby, Emily A Downs, Damien J LaPar, Ravi K Ghanta, Gorav Ailawadi, Benjamin D Kozower, Irving L Kron, Anthony L McCall, James M Isbell
BACKGROUND: Hypoglycemia is a known risk of intensive postoperative glucose control in patients undergoing cardiac operations. However, neither the consequences of hypoglycemia relative to hyperglycemia, nor the possible interaction effects, have been well described. We examined the effects of postoperative hypoglycemia, hyperglycemia, and their interaction on short-term morbidity and mortality. METHODS: Single-institution Society of Thoracic Surgeons (STS) database patient records from 2010 to 2014 were merged with clinical data, including blood glucose values measured in the intensive care unit (ICU)...
August 25, 2016: Annals of Thoracic Surgery
Nam K Tran, Zachary R Godwin, Amanda N Steele, Steven E Wolf, Tina L Palmieri
OBJECTIVES: The goal of this study was to retrospectively evaluate the clinical impact of an accurate autocorrecting blood glucose monitoring system in children with severe burns. Blood glucose monitoring system accuracy is essential for providing appropriate intensive insulin therapy and achieving tight glycemic control in critically ill patients. Unfortunately, few comparison studies have been performed to evaluate the clinical impact of accurate blood glucose monitoring system monitoring in the high-risk pediatric burn population...
September 2016: Pediatric Critical Care Medicine
Palash Kar, Mark P Plummer, Rinaldo Bellomo, Alicia J Jenkins, Andrzej S Januszewski, Marianne J Chapman, Karen L Jones, Michael Horowitz, Adam M Deane
OBJECTIVES: The optimal blood glucose target in critically ill patients with preexisting diabetes and chronic hyperglycemia is unknown. In such patients, we aimed to determine whether a " liberal" approach to glycemic control would reduce hypoglycemia and glycemic variability and appear safe. DESIGN: Prospective, open-label, sequential-period exploratory study. SETTING: Medical-surgical ICU. PATIENTS: During sequential 6-month periods, we studied 83 patients with preexisting type 2 diabetes and chronic hyperglycemia (glycated hemoglobin, ≥ 7...
September 2016: Critical Care Medicine
Jan Gunst, Greet Van den Berghe
No abstract text is available yet for this article.
September 2016: Intensive Care Medicine
Ata Mahmoodpoor, Hadi Hamishehkar, Mohammadtagi Beigmohammadi, Sarvin Sanaie, Kamran Shadvar, Hassan Soleimanpour, Ahsan Rahimi, Saeed Safari
BACKGROUND: Hypoglycemia is a common and the most important complication of intensive insulin therapy in critically ill patients. Because of hypoglycemia's impact on the cardinal organs as a fuel, if untreated it could results in permanent brain damage and increased mortality. OBJECTIVES: In this study, we aim to evaluate the incidence of hypoglycemia, its risk factors, and its relationship with mortality in critically ill patients. PATIENTS AND METHODS: Five hundred adult patients who admitted to an intensive care unit (ICU) were enrolled in this study...
February 2016: Anesthesiology and Pain Medicine
Ata Mahmoodpoor, Hadi Hamishehkar, Kamran Shadvar, Mohammadtaghi Beigmohammadi, Afshin Iranpour, Sarvin Sanaie
BACKGROUND AND AIMS: The association between hyperglycemia and mortality is believed to be influenced by the presence of diabetes mellitus (DM). In this study, we evaluated the effect of preexisting hyperglycemia on the association between acute blood glucose management and mortality in critically ill patients. The primary objective of the study was the relationship between HbA1c and mortality in critically ill patients. Secondary objectives of the study were relationship between Intensive Care Unit (ICU) admission blood glucose and glucose control during ICU stay with mortality in critically ill patients...
February 2016: Indian Journal of Critical Care Medicine
Kent W Stewart, Christopher G Pretty, Hamish Tomlinson, Felicity L Thomas, József Homlok, Szabó Némedi Noémi, Attila Illyés, Geoffrey M Shaw, Balázs Benyó, J Geoffrey Chase
BACKGROUND: The changes in metabolic pathways and metabolites due to critical illness result in a highly complex and dynamic metabolic state, making safe, effective management of hyperglycemia and hypoglycemia difficult. In addition, clinical practices can vary significantly, thus making GC protocols difficult to generalize across units.The aim of this study was to provide a retrospective analysis of the safety, performance and workload of the stochastic targeted (STAR) glycemic control (GC) protocol to demonstrate that patient-specific, safe, effective GC is possible with the STAR protocol and that it is also generalizable across/over different units and clinical practices...
December 2016: Annals of Intensive Care
Lanjuan Xu, Baolin Li, Caifu Yang, Chengjian Li, Yueli Peng
In order to discuss the clinical efficacy of simulation hyperbaric oxygen therapy (HBOT) for severe craniocerebral injury and analyze the related factors of it, 108 patients who transferred to our department during December 2010 - December 2014 for ventilator treatment after operation of severe craniocerebral injury were taken as the subjects of the study. These patients were divided into conventional treatment group and simulation hyperbaric oxygen therapy group to contrast the curative effects. At the meantime, GOS score and length of stay in intensive care unit (ICU) of two groups 6 months after treatment, as well as changes in the indexes of the HBO group during treatment were performed statistical analysis...
January 2016: Pakistan Journal of Pharmaceutical Sciences
Antje Gottschalk, Henryk A Welp, Laura Leser, Christian Lanckohr, Carola Wempe, Björn Ellger
BACKGROUND: Dysregulations of blood glucose (BG) are associated with adverse outcome in critical illness; controlling BG to target appears to improve outcome. Since BG-control is challenging in daily intensive care practice BG-control remains poor especially in patients with rapidly fluctuating BG. To improve BG-control and to avoid deleterious hypoglycemia, automated online-measurement tools are advocated. We thus evaluated the point-accuracy of the subcutaneous Sentrino® Continuous Glucose Monitoring System (CGM, Medtronic Diabetes, Northridge, California) in patients undergoing extracorporeal cardiac life support (ECLS) for cardiogenic shock...
2016: PloS One
Jan Blaha, Barbara Barteczko-Grajek, Pawel Berezowicz, Jiri Charvat, Jiri Chvojka, Teodoro Grau, Jonathan Holmgren, Ulrich Jaschinski, Petr Kopecky, Jan Manak, Mette Moehl, Jonathan Paddle, Marcello Pasculli, Johan Petersson, Sirak Petros, Danilo Radrizzani, Vinodkumar Singh, Joel Starkopf
BACKGROUND: Glycaemia control (GC) remains an important therapeutic goal in critically ill patients. The enhanced Model Predictive Control (eMPC) algorithm, which models the behaviour of blood glucose (BG) and insulin sensitivity in individual ICU patients with variable blood samples, is an effective, clinically proven computer based protocol successfully tested at multiple institutions on medical and surgical patients with different nutritional protocols. eMPC has been integrated into the B...
January 22, 2016: BMC Anesthesiology
Sompop Prathanee, Chusak Kuptanond, Worawit Intanoo, Chawalit Wongbhudha, Chananya Karunasumaeta
BACKGROUND: Many steps of myocardial preservation during open heart surgery are practical after the development of the heart-lung machine. A cardioplegia solution, infused after aortic cross clamping, is an important aspect. Two-thirds of cardioplegia solutions are an intracellular solution (such as HTK or Bretschneider solution) or extracellular solution (such as blood cardioplegia). Intracellular cardioplegia solution can provide protection for 3-4 hours after one-time infusion, which differs from extracellular cardioplegia solution requiring intermittent use every 20-30 minutes...
August 2015: Journal of the Medical Association of Thailand, Chotmaihet Thangphaet
Patricia Stoecklin, Frederik Delodder, Olivier Pantet, Mette M Berger
INTRODUCTION: Hyperglycemia is a metabolic alteration in major burn patients associated with complications. The study aimed at evaluating the safety of general ICU glucose control protocols applied in major burns receiving prolonged ICU treatment. METHODS: 15 year retrospective analysis of consecutive, adult burn patients admitted to a single specialized centre. EXCLUSION CRITERIA: death or length of stay <10 days, age <16 years. VARIABLES: demographic variables, burned surface (TBSA), severity scores, infections, ICU stay, outcome...
February 2016: Burns: Journal of the International Society for Burn Injuries
Wanying Pan, Yueting Wang, Lin Lin, Ge Zhou, Xiaoxiao Hua, Liqiu Mo
BACKGROUND: Dexmedetomidine decreases cardiac complications in adults undergoing cardiovascular surgery. This systematic review assessed whether perioperative dexmedetomidine improves congenital heart disease (CHD) surgery outcomes in children. METHODS: The PubMed, Embase, and Cochrane Library databases were searched for randomized controlled trials (RCTs) or observational studies that were published until 16 April 2015 and compared dexmedetomidine with placebo or an alternative anesthetic agent during pediatric CHD surgery...
March 2016: Paediatric Anaesthesia
Shyoko Honiden, Silvio E Inzucchi
Hyperglycemia is a commonly encountered metabolic derangement in the ICU. Important cellular pathways, such as those related to oxidant stress, immunity, and cellular homeostasis, can become deranged with prolonged and uncontrolled hyperglycemia. There is additionally a complex interplay between nutritional status, ambient glucose concentrations, and protein catabolism. While the nuances of glucose management in the ICU have been debated, results from landmark studies support the notion that for most critically ill patients moderate glycemic control is appropriate, as reflected by recent guidelines...
December 2015: Seminars in Respiratory and Critical Care Medicine
In-Kyung Song, Ji-Hyun Lee, Joo-Eun Kang, Yang-Hyo Park, Hee-Soo Kim, Jin-Tae Kim
Given the benefit of glucose control in the perioperative period, we evaluated the accuracy and performance of the continuous glucose monitoring system (CGMS) depending on different measurement sites in the operating room (OR) and in the intensive care unit (ICU). Patients over 18 years of age scheduled for elective surgery and ICU admission were enrolled prospectively. Two CGMS sensors were inserted into the subcutaneous tissue of the proximal lateral thigh and the lateral abdomen. The rate of successful measurements from thigh and abdomen in the OR and in the ICU were calculated separately...
November 11, 2015: Journal of Clinical Monitoring and Computing
Alfonso Mesejo, Juan Carlos Montejo-González, Clara Vaquerizo-Alonso, Gabriela Lobo-Tamer, Mercedes Zabarte-Martinez, Jose Ignacio Herrero-Meseguer, Jose Acosta-Escribano, Antonio Blesa-Malpica, Fátima Martinez-Lozano
INTRODUCTION: Although standard enteral nutrition is universally accepted, the use of disease-specific formulas for hyperglycemic patients is still controversial. This study examines whether a high-protein diabetes-specific formula reduces insulin needs, improves glycemic control and reduces ICU-acquired infection in critically ill, hyperglycemic patients on mechanical ventilation (MV). METHODS: This was a prospective, open-label, randomized (web-based, blinded) study conducted at nine Spanish ICUs...
2015: Critical Care: the Official Journal of the Critical Care Forum
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