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Báo cáo y học: "Tight blood glucose control: a recommendation applicable to any critically ill patient"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care cung cấp cho các bạn kiến thức về ngành y đề tài: Tight blood glucose control: a recommendation applicable to any critically ill patient? | Available online http ccforum.eom content 8 6 427 Commentary Tight blood glucose control a recommendation applicable to any critically ill patient Philippe Devos1 and Jean-Charles Preiser2 1 Resident Department of Intensive Care Centre Hospitalier Universitaire du Sart Tilman Liege Belgium 2Clinical Director Department of Intensive Care Centre Hospitalier Universitaire du Sart Tilman Liege Belgium Corresponding author Jean-Charles Preiser Jean-Charles.Preiser@chu.ulg.ac.be Published online 27 October 2004 This article is online at http ccforum.com content 8 6 427 2004 BioMed Central Ltd Related to Research by Vriesendorp et al. see page 513 Critical Care 2004 8 427-429 DOI 10.1186 cc2989 Abstract The issue of tight glucose control with intensive insulin therapy in critically ill patients remains controversial. Although compelling evidence supports this strategy in postoperative patients who have undergone cardiac surgery the use of tight glucose control has been challenged in other situations including in medical critically ill patients and in those who have undergone non-cardiac surgery. Similarly the mechanisms that underlie the effects of high-dose insulin are not fully elucidated. These arguments emphasize the need to study the effects of tight glucose control in a large heterogeneous cohort of intensive care unit patients. Keywords cardiac surgery critically ill hyperglycemia insulin metabolism Until the end of the past millenium relatively little attention was given to control of blood sugar levels. In critically ill patients hyperglycaemia was considered to be physiological because it results from the metabolic and hormonal changes that accompany the stress response to injury. In most intensive care units ICUs blood sugar was checked every 4-6 hours and hyperglycaemia defined as blood sugar levels 10-12 mmol l 180-216 mg dl was corrected by subcutaneous or intravenous insulin. The presence of pre-existing diabetes mellitus or post-neurosurgical status often