Glycemic control in the burn intensive care unit: focus on the role of anemia in glucose measurement.
Glycemic control with intensive insulin therapy (IIT) has received widespread adoption secondary to findings of improved clinical outcomes and survival in the burn population. Severe burn as a model for trauma is characterized by a hypermetabolic state, hyperglycemia, and insulin resistance. In this article, we review the findings of a burn center research facility in terms of understanding glucose management. The conferred benefits from IIT, our findings of poor outcomes associated with glycemic variability, advantages from preserved diurnal variation of glucose and insulin, and impacts of glucometer error and hematocrit correction factor are discussed. We conclude with direction for further study and the need for a reliable continuous glucose monitoring system. Such efforts will further the endeavor for achieving adequate glycemic control in order to assess the efficacy of target ranges and use of IIT.
Mann
Elizabeth A
EA
U.S. Army Institute of Surgical Research, Brooke Army Medical Center, San Antonio, Texas 78234-6315, USA. Elizabeth.Mann@us.army.mil
Mora
Alejandra G
AG
Pidcoke
Heather F
HF
Wolf
Steven E
SE
Wade
Charles E
CE
D000740:Anemia / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism*; D015190:Blood Glucose Self-Monitoring / Q000295:instrumentation; D002056:Burns / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D002940:Circadian Rhythm; D003422:Critical Care; D019719:Diagnostic Equipment; D006400:Hematocrit; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D007328:Insulin / Q000008:administration & dosage; D007362:Intensive Care Units; D019397:Pancreas, Artificial; D019095:Point-of-Care Systems; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D016896:Treatment Outcome
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin