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Intensive insulin therapy for critically ill patients.
Ann Pharmacother. 2004 Jul-Aug; 38(7-8):1243-51.AP

Abstract

OBJECTIVE

To evaluate the clinical outcomes of glycemic control of intensive insulin therapy and recommend its place in the management of critically ill patients.

DATA SOURCES

Searches of MEDLINE (1966-March 2004) and Cochrane Library, as well as an extensive manual review of abstracts were performed using the key search terms hyperglycemia, insulin, intensive care unit, critically ill, outcomes, and guidelines and algorithms.

STUDY SELECTION AND DATA EXTRACTION

All articles identified from the data sources were evaluated and deemed relevant if they included and assessed clinical outcomes.

DATA SYNTHESIS

Mortality among patients with prolonged critical illness exceeds 20%, and most deaths are attributable to sepsis and multisystem organ failure. Hyperglycemia is common in critically ill patients, even in those with no history of diabetes mellitus. Maintaining normoglycemia with insulin in critically ill patients has been shown to improve neurologic, cardiovascular, and infectious outcomes. Most importantly, morbidity and mortality are reduced with aggressive insulin therapy. This information can be implemented into protocols to maintain strict control of glucose.

CONCLUSIONS

Use of insulin protocols in critically ill patients improves blood glucose control and reduces morbidity and mortality in critically ill populations. Glucose levels in critically ill patients should be controlled through implementation of insulin protocols with the goal to achieve normoglycemia, regardless of a history of diabetes. Frequent monitoring is imperative to avoid hypoglycemia.

Authors+Show Affiliations

Associate Professor of Anesthesiology, Division of Critical Care, Rush Presbyterian St Luke's Medical Center, Chicago, IL, USA.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15187219

Citation

Lewis, Kelly S., et al. "Intensive Insulin Therapy for Critically Ill Patients." The Annals of Pharmacotherapy, vol. 38, no. 7-8, 2004, pp. 1243-51.
Lewis KS, Kane-Gill SL, Bobek MB, et al. Intensive insulin therapy for critically ill patients. Ann Pharmacother. 2004;38(7-8):1243-51.
Lewis, K. S., Kane-Gill, S. L., Bobek, M. B., & Dasta, J. F. (2004). Intensive insulin therapy for critically ill patients. The Annals of Pharmacotherapy, 38(7-8), 1243-51.
Lewis KS, et al. Intensive Insulin Therapy for Critically Ill Patients. Ann Pharmacother. 2004 Jul-Aug;38(7-8):1243-51. PubMed PMID: 15187219.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intensive insulin therapy for critically ill patients. AU - Lewis,Kelly S, AU - Kane-Gill,Sandra L, AU - Bobek,Mary Beth, AU - Dasta,Joseph F, Y1 - 2004/06/08/ PY - 2004/6/10/pubmed PY - 2004/10/7/medline PY - 2004/6/10/entrez SP - 1243 EP - 51 JF - The Annals of pharmacotherapy JO - Ann Pharmacother VL - 38 IS - 7-8 N2 - OBJECTIVE: To evaluate the clinical outcomes of glycemic control of intensive insulin therapy and recommend its place in the management of critically ill patients. DATA SOURCES: Searches of MEDLINE (1966-March 2004) and Cochrane Library, as well as an extensive manual review of abstracts were performed using the key search terms hyperglycemia, insulin, intensive care unit, critically ill, outcomes, and guidelines and algorithms. STUDY SELECTION AND DATA EXTRACTION: All articles identified from the data sources were evaluated and deemed relevant if they included and assessed clinical outcomes. DATA SYNTHESIS: Mortality among patients with prolonged critical illness exceeds 20%, and most deaths are attributable to sepsis and multisystem organ failure. Hyperglycemia is common in critically ill patients, even in those with no history of diabetes mellitus. Maintaining normoglycemia with insulin in critically ill patients has been shown to improve neurologic, cardiovascular, and infectious outcomes. Most importantly, morbidity and mortality are reduced with aggressive insulin therapy. This information can be implemented into protocols to maintain strict control of glucose. CONCLUSIONS: Use of insulin protocols in critically ill patients improves blood glucose control and reduces morbidity and mortality in critically ill populations. Glucose levels in critically ill patients should be controlled through implementation of insulin protocols with the goal to achieve normoglycemia, regardless of a history of diabetes. Frequent monitoring is imperative to avoid hypoglycemia. SN - 1060-0280 UR - https://www.unboundmedicine.com/medline/citation/15187219/Intensive_insulin_therapy_for_critically_ill_patients_ L2 - https://journals.sagepub.com/doi/10.1345/aph.1D211?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -