Insulin therapy in critically ill patients.
OBJECTIVE
The recent publication of the results of an aggressive approach to the treatment of hyperglycaemia in critically ill patients, and a rekindling of interest in the use of an infusion of glucose insulin and potassium as adjunctive therapy in a diverse group of patients with cardiovascular disease, warrants a review of the multiple effects of insulin and a review of laboratory and clinical studies.


RESULTS
The use of an aggressive protocol to maintain normoglycaemia in critically ill patients has been demonstrated to be a beneficial technique in the critical care setting. Implementation of the protocol outside of a research setting appears to be feasible. Recent studies on the use of insulin in addition to glucose and potassium in patients with diverse cardiovascular diseases have also demonstrated positive results.


CONCLUSIONS
This review will summarize some of the putative beneficial effects of insulin as a pharmacological agent, and review recent clinical data. Although the relative benefits of normoglycaemia in the critical care setting and the beneficial effects of insulin are difficult to differentiate, a substantial overlap exists. The extent to which these converging therapies (aggressive normoglycaemia and insulin pharmacotherapy) will be applicable to diverse clinical settings has yet to be determined.
Solano
Thomas
T
General Intensive Care Unit, Royal Prince Alfred Hospital, Camperdown, New South Wales 2050, Australia. thomas.solano@email.cs.nsw.gov.au
Totaro
Richard
R
D000818:Animals; D001786:Blood Glucose / Q000378:metabolism; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness / Q000628:therapy*; D005947:Glucose / Q000008:administration & dosage; D006801:Humans; D006943:Hyperglycemia / Q000150:complications / Q000188:drug therapy* / Q000209:etiology; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D007362:Intensive Care Units; D009203:Myocardial Infarction / Q000503:physiopathology / Q000628:therapy; D011188:Potassium / Q000008:administration & dosage; D016896:Treatment Outcome
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D005947:Glucose; D011188:Potassium