[Hyperglycemia in the critically ill: meaning and treatment].
Hyperglycemia is commun in critically ill patients without previously known diabetes. Hyperglycemia occurring in these patients is mainly a consequence of stress associated to complex glucose metabolism abnormalities which have deleterious effects on tissues and vascular function. Several epidemiologic and intervention studies had established that hyperglycemia is related to morbidity and mortality. Maintenance of normoglycemia with intensive insulin therapy seems to decrease morbidity and mortalities in severe acute illnesses. However the benefit of most of these intervention trials remain controversial mainly in stroke, myocardial infarction and severe sepsis. Moreover strict normoglycemia required to obtain an optimal benefit increases the risk of hypoglycaemia which may be particularly harmful in patients in critical state.
Schlienger
Jean-Louis
JL
Service de médecine interne et nutrition, Hôpital de Hautepierre, F-67098 Strasbourg Cedex, France. Jean-louis.schlienger@chru-strasbourg.fr
Pradignac
Alain
A
Vinzio
Stéphane
S
Luca
Florina
F
Suna
Carmen
C
Grunenberger
Fabienne
F
Goichot
Bernard
B
D003422:Critical Care; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D004734:Energy Metabolism / Q000502:physiology; D017052:Hospital Mortality; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000188:drug therapy* / Q000401:mortality; D007003:Hypoglycemia / Q000097:blood / Q000139:chemically induced / Q000401:mortality; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects; D009203:Myocardial Infarction / Q000097:blood / Q000150:complications / Q000188:drug therapy / Q000401:mortality; D011379:Prognosis; D012151:Resuscitation; D018570:Risk Assessment; D012307:Risk Factors; D018805:Sepsis / Q000097:blood / Q000150:complications / Q000188:drug therapy / Q000401:mortality; D013312:Stress, Physiological / Q000502:physiology; D020521:Stroke / Q000097:blood / Q000150:complications / Q000188:drug therapy / Q000401:mortality; D016019:Survival Analysis; D016896:Treatment Outcome
D007328:Insulin