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Glucose control critically ill

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https://www.readbyqxmd.com/read/29778648/impact-of-insulin-on-the-intestinal-microcirculation-in-a-model-of-sepsis-related-hyperglycemia
#1
Alexa Caldwell, Jan Niklas Morick, Anne-Marie Jentsch, Annette Wegener, Dragan Pavlovic, Nadia Al-Banna, Christian Lehmann
BACKGROUND: Sepsis involves dysfunctional glucose metabolism. Among patients with sepsis, hyperglycemia is frequent and insulin administration has been evaluated for glycemic control to improve patient outcomes. Only few studies have examined the hyperglycemic microcirculation and the impact of insulin on the microvasculature in sepsis. OBJECTIVE: To study the functional capillary density (FCD) and leukocyte activation within the intestinal microcirculation in endotoxin-induced experimental sepsis...
May 17, 2018: Microvascular Research
https://www.readbyqxmd.com/read/29759263/a-bedside-computerized-decision-support-tool-for-intravenous-insulin-infusion-management-in-critically-ill-patients
#2
Evan D Telford, Andrew J Franck, Andrew L Hendrickson, Nicole Maltese Dietrich
Intravenous (IV) insulin infusions using a validated protocol are the recommended method for blood glucose control in critically ill patients. Computerized decision-support tools improve quality over manual paper-based protocols. However, nonproprietary computerized tools targeting the recommended blood glucose range of 140-180 mg/dL are not readily available. A bedside computerized decision-support tool was developed at a US Department of Veterans Affairs health system to assist the nursing staff with the management of patients requiring IV insulin infusion...
May 2018: Joint Commission Journal on Quality and Patient Safety
https://www.readbyqxmd.com/read/29757412/development-of-a-provincial-initiative-to-improve-glucose-control-in-critically-ill-patients
#3
Peter Dodek, Shari McKeown, Eric Young, Vinay Dhingra
Objective: To describe the development, implementation and initial evaluation of an initiative to improve glucose control in critically ill patients. Design: Glucose control in critically ill patients was chosen by critical care leaders as a target for improvement. This was an observational study to document changes in processes and measures of glucose control in each intensive care unit (ICU). ICU nurse educators were interviewed to document relevant changes between April 2012 and April 2016...
May 11, 2018: International Journal for Quality in Health Care
https://www.readbyqxmd.com/read/29727367/insidious-harm-of-medication-diluents-as-a-contributor-to-cumulative-volume-and-hyperchloremia-a-prospective-open-label-sequential-period-pilot-study
#4
Carolyn A Magee, Melissa L Thompson Bastin, Melanie E Laine, Brittany D Bissell, Gavin T Howington, Peter R Moran, Emily J McCleary, Gary D Owen, Lauren E Kane, Emily A Higdon, Cathy A Pierce, Peter E Morris, Alexander H Flannery
OBJECTIVES: Although the potential dangers of hyperchloremia from resuscitation fluids continue to emerge, no study to date has considered the contribution of medication diluents to cumulative volume and hyperchloremia. This study compares saline versus dextrose 5% in water as the primary medication diluent and the occurrence of hyperchloremia in critically ill patients. DESIGN: Prospective, open-label, sequential period pilot study. SETTING: Medical ICU of a large academic medical center...
May 4, 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29725969/differences-in-glycemic-control-in-diabetic-and-non-diabetic-patients-with-parenteral-nutrition-using-a-basal-plus-correction-insulin-regimen-an-observational-retrospective-study
#5
Analía Ramos, Fernanda Rabasa, Lilian Mendoza, Joana Cardenete, Pedro Gill, Alba Morilla, Daniel Cardona, Antonio Pérez
INTRODUCTION: Hyperglycemia is a frequent complication of parenteral nutrition (PN) in patients both with and without diabetes mellitis (DM). The aim of this study was to evaluate the quality of glucose control achieved with basal plus-correction insulin in surgical patients with and without a history of DM receiving PN. METHODS: Retrospective evaluation of a protocol applied during the period of January 2013-December 2015. The insulin dose was started at 0.4 and 0...
May 3, 2018: Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders
https://www.readbyqxmd.com/read/29705217/lower-glucose-target-is-associated-with-improved-30-day-mortality-in-cardiac-and-cardiothoracic-patients
#6
Andrew M Hersh, Eliotte L Hirshberg, Emily L Wilson, James F Orme, Alan H Morris, Michael J Lanspa
BACKGROUND: Practice guidelines recommend against Intensive Insulin Therapy (IIT) in critically ill patients based on trials that had high rates of severe hypoglycemia. Intermountain Healthcare uses a computerized intravenous insulin protocol (eProtocol-insulin) that allows choice of blood glucose (BG) targets (80-110 mg/dl versus 90-140 mg/dl), and has low rates of severe hypoglycemia. We sought to study the effects of BG target on mortality in adult patients in cardiac intensive care units (ICUs) that have very low rates of severe hypoglycemia...
April 26, 2018: Chest
https://www.readbyqxmd.com/read/29688879/managing-diabetes-in-patients-hospitalized-in-internal-medicine-units
#7
Irit Hochberg
Diabetes and hyperglycemia are present in over one-third of inpatients in internal medicine units and are associated with worse prognosis in multiple morbidities. Treatment of inpatient hyperglycemia is usually with basal bolus insulin in a dose calculated by the patient's weight, with lower doses recommended in patients who are at a higher risk for hypoglycemia. Other antihyperglycemic medications and insulin regimens can be used in selected patients. There are no adequately powered studies on the effect of improving glycemic control on hospitalization outcomes in non-critically ill patients in internal medicine units, and in most patients a modest glucose target of 140-180 mg/dL is recommended...
April 19, 2018: Rambam Maimonides Medical Journal
https://www.readbyqxmd.com/read/29657375/comparison-of-glycemic-control-between-continuous-regular-insulin-infusion-and-single-dose-subcutaneous-insulin-glargine-injection-in-medical-critically-ill-patients
#8
Rungsun Bhurayanontachai, Tharittamon Rattanaprapat, Chanon Kongkamol
Background and Aims: This study aimed to compare glycemic control between continuous intravenous regular insulin infusion and single-dose subcutaneous insulin glargine injection in medical critically ill patients. Subjects and Methods: A prospective noninferiority study was conducted in medical critically ill patients who developed hyperglycemia and required regular insulin infusion by the Intensive Care Unit glycemic control protocol. The eligible patients were switched from the daily regular insulin requirement to single-dose subcutaneous insulin glargine injection by a 100% conversion dose...
March 2018: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/29643977/role-and-possible-mechanisms-of-sirt1-in-depression
#9
REVIEW
Guofang Lu, Jianguo Li, Hongmei Zhang, Xin Zhao, Liang-Jun Yan, Xiaorong Yang
Depression is a common, devastating illness. Due to complicated causes and limited treatments, depression is still a major problem that plagues the world. Silent information regulator 1 (Sirt1) is a deacetylase at the consumption of NAD+ and is involved in gene silencing, cell cycle, fat and glucose metabolism, cellular oxidative stress, and senescence. Sirt1 has now become a critical therapeutic target for a number of diseases. Recently, a genetic study has received considerable attention for depression and found that Sirt1 is a potential gene target...
2018: Oxidative Medicine and Cellular Longevity
https://www.readbyqxmd.com/read/29604150/neurophysiological-study-of-critical-illness-polyneuropathy-and-myopathy-in-mechanically-ventilated-children-additional-aspect-into-pediatric-critical-illness-comorbidities
#10
Ahmed Thabet Mahmoud, Maha A M Tawfik, Sameh Abdallah Abd El Naby, Wafaa Moustafa M Abo El Fotoh, Nagwan Yossery Saleh, Nahla M Said Abd El Hady
BACKGROUND: Critical illness polyneuropathy and myopathy (CIP/CIM) is being increasingly recognized as a significant clinical problem in critically ill children especially who have spent long periods in the intensive care unit. So we aimed to determine the frequency of CIP/CIM among mechanically ventilated children and to analyze the associated risk factors and drawbacks frequently encountered in this cohort. METHODS: The study included 105 patients admitted to the pediatric intensive care unit and underwent mechanical ventilation for ≥7 days...
March 31, 2018: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
https://www.readbyqxmd.com/read/29519778/outcome-of-critically-ill-patients-undergoing-mandatory-insulin-therapy-compared-to-usual-care-insulin-therapy-protocol-for-a-pilot-randomized-controlled-trial
#11
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
https://www.readbyqxmd.com/read/29518765/from-treating-childhood-malnutrition-to-public-health-nutrition
#12
W Philip T James
BACKGROUND: This analysis sets out an overview of an IUNS presentation of a European clinician's assessment of the challenges of coping with immediate critical clinical problems and how to use metabolic and a mechanistic understanding of disease when developing nutritional policies. SUMMARY: Critically ill malnourished children prove very sensitive to both mineral and general nutritional overload, but after careful metabolic control they can cope with a high-quality, energy-rich diet provided their initial lactase deficiency and intestinal atrophy are taken into account...
2018: Annals of Nutrition & Metabolism
https://www.readbyqxmd.com/read/29501063/tight-glycemic-control-in-critically-ill-pediatric-patients-a-systematic-review-and-meta-analysis
#13
Lvlin Chen, Tiangui Li, Fang Fang, Yu Zhang, Andrew Faramand
BACKGROUND: Hyperglycemia is prevalent in patients in the pediatric intensive care unit. The purpose of this study was to describe the benefits and risks of tight glucose control (TGC) in critically ill children. METHODS: A systemic review and meta-analysis of the literature was carried out on randomized controlled trials of TGC in critically ill children admitted to the pediatric intensive care unit. The databases searched were Medline, Embase, and CENTRAL databases until May 1, 2017...
March 4, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29479638/critical-care-management-of-stress-induced-hyperglycemia
#14
REVIEW
Ilse Vanhorebeek, Jan Gunst, Greet Van den Berghe
PURPOSE OF REVIEW: We discuss key studies that have set the scene for the debate on the efficacy and safety of tight glycemic control in critically ill patients, highlighting important differences among them, and describe the ensuing search towards strategies for safer glucose control. RECENT FINDINGS: Differences in level of glycemic control, glucose measurement and insulin administration, expertise, and nutritional management may explain the divergent outcomes of the landmark studies on tight glycemic control in critical illness...
February 26, 2018: Current Diabetes Reports
https://www.readbyqxmd.com/read/29459791/different-enteral-nutrition-formulas-have-no-effect-on-glucose-homeostasis-but-on-diet-induced-thermogenesis-in-critically-ill-medical-patients-a-randomized-controlled-trial
#15
Marlene Wewalka, Andreas Drolz, Berit Seeland, Mathias Schneeweiss, Monika Schmid, Bruno Schneeweiss, Christian Zauner
BACKGROUND/OBJECTIVES: Hyperglycemia is common in critically ill patients and associated with increased mortality. It has been suggested that different nutrition formulas may beneficially influence glucose levels in surgical intensive care patients. In this prospective randomized clinical cohort study we investigated glucose homeostasis in response to different enteral nutrition formulas in medical critically ill patients. SUBJECTS/METHODS: 60 medical critically ill patients were randomized to receive continuous fat-based (group A, n = 30) or glucose-based enteral nutrition (group B, n = 30) for seven days...
April 2018: European Journal of Clinical Nutrition
https://www.readbyqxmd.com/read/29444446/pathophysiological-changes-after-lipopolysaccharide-induced-acute-inflammation-in-a-type-2-diabetic-rat-model-versus-normal-controls
#16
Tingting Han, Xingxing Ren, Dongdong Jiang, Shuang Zheng, Yawen Chen, Huiying Qiu, Peter C Hou, Wei Liu, Yaomin Hu
AIMS: The present study aimed to explore the mechanism of a potential beneficial effect of pre-existing diabetes in acute hyperglycemia during critical illness. METHODS: Pathophysiological changes including blood glucose variability, changes of inflammatory and oxidative stress responses after lipopolysaccharide (LPS)-induced acute infection were compared between type 2 diabetic rat model (GK rats) and normal controls (Wistar rats). RESULTS: After LPS injection, Wistar rats showed serious infective symptoms while GK rats did not...
April 2018: Diabetes Research and Clinical Practice
https://www.readbyqxmd.com/read/29428919/randomized-control-trial-comparing-pain-control-interventions-in-preterm-neonates
#17
Vivek V Shukla, Satvik Bansal, Archana Nimbalkar, Apurva Chapla, Ajay Phatak, Dipen Patel, Somashekhar Nimbalkar
OBJECTIVE: To compare individual efficacy and additive effects of pain control interventions in preterm neonates. DESIGN: Randomized controlled trial. SETTING: Level-3 University affiliated neonatal intensive care unit. PARTICIPANTS: 200 neonates (26-36 weeks gestational age) requiring heel-stick for bedside glucose assessment. Exclusion criteria were neurologic impairment and critical illness precluding study interventions...
February 9, 2018: Indian Pediatrics
https://www.readbyqxmd.com/read/29407052/perioperative-management-of-hyperglycemia-and-diabetes-in-cardiac-surgery-patients
#18
REVIEW
Rodolfo J Galindo, Maya Fayfman, Guillermo E Umpierrez
Perioperative hyperglycemia is common after cardiac surgery, reported in 60% to 90% of patients with diabetes and in approximately 60% of patients without history of diabetes. Many observational and prospective randomized trials in critically-ill cardiac surgery patients support a strong association between hyperglycemia and poor clinical outcome. Despite ongoing debate about the optimal glucose target, there is strong agreement that improved glycemic control reduces perioperative complications.
March 2018: Endocrinology and Metabolism Clinics of North America
https://www.readbyqxmd.com/read/29402368/-efficacy-and-safety-of-simulated-artificial-pancreas-in-modulating-stress-hyperglycemia-in-critically-ill-patients-a-prospective-randomized-controlled-study
#19
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
https://www.readbyqxmd.com/read/29401030/road-map-for-diffusion-of-innovation-in-health-care
#20
E Andrew Balas, Wendy W Chapman
New scientific knowledge and innovation are often slow to disseminate. In other cases, providers rush into adopting what appears to be a clinically relevant innovation, based on a single clinical trial. In reality, adopting innovations without appropriate translation and repeated testing of practical application is problematic. In this article we provide examples of clinical innovations (for example, tight glucose control in critically ill patients) that were adopted inappropriately and that caused what we term a malfunction...
February 2018: Health Affairs
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