Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Formulas Pro/con debate: Is intensive insulin therapy targeting tight blood glucose control of benefit in critically ill patients? | Available online http content 12 2 212 Review Pro con debate Is intensive insulin therapy targeting tight blood glucose control of benefit in critically ill patients Tobias M Merz and Simon Finfer Department of Intensive Care Medicine Royal North Shore Hospital of Sydney St Leonards 2065 NSW Australia Corresponding author Simon Finfer sfinfer@ Published 25 April 2008 This article is online at http content 12 2 212 2008 BioMed Central Ltd Critical Care 2008 12 212 doi cc6837 Abstract You have decided to develop a protocol for insulin therapy in your intensive care unit ICU . You wonder about the merit of using intensive insulin therapy IIT to maintain tight blood glucose control in your patients. Pro Intensive insulin therapy targeting tight blood glucose control is of benefit in critically ill patients Hyperglycaemia is a common accompaniment of acute illness. In published trials insulin treatment was required in more than 98 of ICU patients in whom the goal was to maintain normoglycaemia 1-3 . The hyperglycaemia is thought to result from a number of processes elevated levels of cortisol epinephrine norepinephrine and glucagon increase gluconeogenesis 4-8 and glycogenolysis 9 whilst insulin resistance leads to a decrease in insulin-stimulated uptake of glucose in heart and adipose tissue. In addition exercise induced uptake of glucose in skeletal muscle is absent in immobilized critically ill patients 10 11 . Hyperglycaemia may cause harm by direct toxicity and through increased intracellular oxidative stress due to higher mitochondrial peroxide production 12 13 . The clinical consequence of hyperglycaemia appears to be an increase in morbidity and mortality in a variety of clinical settings including heterogeneous populations of critically ill patients 14 . In trauma patients hyperglycaemia is associated with higher mortality and an increased rate of infectious complications 15 as well as with worse neurological outcome
