Tight control of glycaemia in critically ill patients.
OBJECTIVE
This manuscript attempts to review the effects associated with hyperglycaemia in critically ill patients and the effects of various insulin regimens. The available clinical findings and pertinent experimental data are examined.


RESULTS
Intensive insulin therapy titrated to maintain blood glucose level between 4.4 and 6.1 mmol/l during intensive care unit stay has recently been shown to significantly decrease mortality, septic morbidity, sepsis-related organ failure, transfusion requirements and polyneuropathies. Prior studies have already documented that hyperglycaemia on admission is related to susceptibility to infections and worse outcomes following myocardial and cerebral ischaemic events. Additional effects of insulin, unrelated to the control of glycaemia, have also been reported.


CONCLUSIONS
Intensive insulin therapy is probably warranted in most categories of critically ill patients, although some of the underlying mechanisms of its beneficial effects still need to be elucidated.
Preiser
Jean-Charles
JC
Department of Intensive Care of RHMS Tournai and Erasme University Hospital, Brussels, Belgium. preiserj@ulb.ac.be
Devos
Philippe
P
Van den Berghe
Greet
G
D001786:Blood Glucose; D002545:Brain Ischemia / Q000097:blood / Q000150:complications; D016638:Critical Illness / Q000401:mortality / Q000628:therapy; D017052:Hospital Mortality; D006801:Humans; D006943:Hyperglycemia / Q000150:complications / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007239:Infections / Q000209:etiology; D007328:Insulin / Q000097:blood / Q000627:therapeutic use*; D007362:Intensive Care Units; D007902:Length of Stay; D017202:Myocardial Ischemia / Q000097:blood / Q000150:complications; D016896:Treatment Outcome
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin