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Tight glucose control in intensive care units: an update with an emphasis on nutritional issues.
Curr Opin Clin Nutr Metab Care. 2008 Jul; 11(4):465-70.CO

Abstract

PURPOSE OF REVIEW

Tight glucose control in ICU patients is now regarded as a goal of successful care. Some challenge this on the basis that it produces no benefit and may cause harm. We review the recent literature with an emphasis on nutritional aspects.

RECENT FINDINGS

Since 2001, several randomized controlled trials have examined the effect of tight glucose control in ICU patients, but only one showed an overall survival benefit. Glucose potassium insulin infusions have also produced variable results, and sometimes cause falls in plasma phosphate with potential consequences. Several studies have shown tight glucose control is labour-intensive and increases the incidence of hypoglycaemia, which could have profound effects, especially if cerebral perfusion is poor. Nutritional intake during tight glucose control has generally been poorly defined. Unintentional cessation of nutrition has been identified as a risk factor for hypoglycaemia. No difference in glucose control has been found between parenteral and enteral feeding.

SUMMARY

Without knowledge of nutrition provision in terms of carbohydrate, total energy intake and route of administration, some studies are difficult to interpret. It is currently difficult to recommend routine use of tight glucose control in the ICU. Many clinicians have adopted regimes to control glucose between 5.0-9.0 mmol/l.

Authors+Show Affiliations

aInstitute of Human Nutrition, University of Southampton, Southampton, UK. elia@soton.ac.ukNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

18542008

Citation

Elia, Marinos, and Aminda De Silva. "Tight Glucose Control in Intensive Care Units: an Update With an Emphasis On Nutritional Issues." Current Opinion in Clinical Nutrition and Metabolic Care, vol. 11, no. 4, 2008, pp. 465-70.
Elia M, De Silva A. Tight glucose control in intensive care units: an update with an emphasis on nutritional issues. Curr Opin Clin Nutr Metab Care. 2008;11(4):465-70.
Elia, M., & De Silva, A. (2008). Tight glucose control in intensive care units: an update with an emphasis on nutritional issues. Current Opinion in Clinical Nutrition and Metabolic Care, 11(4), 465-70. https://doi.org/10.1097/MCO.0b013e3282fcea2a
Elia M, De Silva A. Tight Glucose Control in Intensive Care Units: an Update With an Emphasis On Nutritional Issues. Curr Opin Clin Nutr Metab Care. 2008;11(4):465-70. PubMed PMID: 18542008.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Tight glucose control in intensive care units: an update with an emphasis on nutritional issues. AU - Elia,Marinos, AU - De Silva,Aminda, PY - 2008/6/11/pubmed PY - 2008/10/18/medline PY - 2008/6/11/entrez SP - 465 EP - 70 JF - Current opinion in clinical nutrition and metabolic care JO - Curr Opin Clin Nutr Metab Care VL - 11 IS - 4 N2 - PURPOSE OF REVIEW: Tight glucose control in ICU patients is now regarded as a goal of successful care. Some challenge this on the basis that it produces no benefit and may cause harm. We review the recent literature with an emphasis on nutritional aspects. RECENT FINDINGS: Since 2001, several randomized controlled trials have examined the effect of tight glucose control in ICU patients, but only one showed an overall survival benefit. Glucose potassium insulin infusions have also produced variable results, and sometimes cause falls in plasma phosphate with potential consequences. Several studies have shown tight glucose control is labour-intensive and increases the incidence of hypoglycaemia, which could have profound effects, especially if cerebral perfusion is poor. Nutritional intake during tight glucose control has generally been poorly defined. Unintentional cessation of nutrition has been identified as a risk factor for hypoglycaemia. No difference in glucose control has been found between parenteral and enteral feeding. SUMMARY: Without knowledge of nutrition provision in terms of carbohydrate, total energy intake and route of administration, some studies are difficult to interpret. It is currently difficult to recommend routine use of tight glucose control in the ICU. Many clinicians have adopted regimes to control glucose between 5.0-9.0 mmol/l. SN - 1363-1950 UR - https://www.unboundmedicine.com/medline/citation/18542008/Tight_glucose_control_in_intensive_care_units:_an_update_with_an_emphasis_on_nutritional_issues_ L2 - https://doi.org/10.1097/MCO.0b013e3282fcea2a DB - PRIME DP - Unbound Medicine ER -