[Insulin infusion for critically ill patients].
BACKGROUND
Stress, acute illness and surgery are known to increase blood sugar. Hyperglycaemia in critically ill patients is associated with increased mortality irrespective of diabetes status. The effect of treating critically ill patients with insulin infusions has been assessed in many randomised trials in recent years. Possible mechanisms related to hyperglycaemia and the effects of insulin have also been studied.


METHODS
The present review is based on a systematic Medline search, references in key articles, and our personal clinical experience.


RESULTS
The effect of reducing blood glucose to normal levels is best documented in patients with myocardial infarction and in those receiving intensive care. Insulin therapy should be considered when plasma glucose levels exceed 8 mmol/L; the treatment target is 4-6 mmol/L. There is a low risk of serious hypoglycaemia according to our experience, but systematic monitoring of blood glucose is important.


CONCLUSIONS
Insulin therapy is an inexpensive and safe way to improve outcome in critically ill patients. Insulin infusions should therefore be used more to treat hyperglycaemia in critically ill hospitalized patients, especially in coronary care- and intensive care units.
Skeie
Svein
S
Endokrinologisk seksjon, Medisinsk klinikk, Stavanger universitetssjukehus, Postboks 8100, 4068 Stavanger. sksv@sus.no
Søreide
Eldar
E
Cooper
John
J
D000208:Acute Disease; D003422:Critical Care; D016638:Critical Illness / Q000628:therapy*; D019317:Evidence-Based Medicine; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy* / Q000209:etiology; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage*; D011182:Postoperative Care; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D007004:Hypoglycemic Agents; D007328:Insulin