International recommendations for glucose control in adult non diabetic critically ill patients.
BACKGROUND
The purpose of this research is to provide recommendations for the management of glycemic control in critically ill patients.


METHODS
Twenty-one experts issued recommendations related to one of the five pre-defined categories (glucose target, hypoglycemia, carbohydrate intake, monitoring of glycemia, algorithms and protocols), that were scored on a scale to obtain a strong or weak agreement. The GRADE (Grade of Recommendation, Assessment, Development and Evaluation) system was used, with a strong recommendation indicating a clear advantage for an intervention and a weak recommendation indicating that the balance between desirable and undesirable effects of an intervention is not clearly defined.


RESULTS
A glucose target of less than 10 mmol/L is strongly suggested, using intravenous insulin following a standard protocol, when spontaneous food intake is not possible. Definition of the severe hypoglycemia threshold of 2.2 mmol/L is recommended, regardless of the clinical signs. A general, unique amount of glucose (enteral/parenteral) to administer for any patient cannot be suggested. Glucose measurements should be performed on arterial rather than venous or capillary samples, using central lab or blood gas analysers rather than point-of-care glucose readers.


CONCLUSIONS
Thirty recommendations were obtained with a strong (21) and a weak (9) agreement. Among them, only 15 were graded with a high level of quality of evidence, underlying the necessity to continue clinical studies in order to improve the risk-to-benefit ratio of glucose control.
Ichai
Carole
C
Medical and Surgical Intensive Care Unit, Saint-Roch Hospital, University of Medicine of Nice, 06000 Nice, France. ichai@unice.fr
Preiser
Jean-Charles
JC
D000328:Adult; D000367:Age Factors; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism*; D003422:Critical Care / Q000379:methods / Q000592:standards*; D016638:Critical Illness / Q000453:epidemiology / Q000628:therapy*; D005947:Glucose / Q000378:metabolism; D038321:Glycemic Index / Q000187:drug effects / Q000502:physiology*; D006287:Health Planning Guidelines; D006801:Humans; D007328:Insulin / Q000494:pharmacology / Q000627:therapeutic use; D038622:Internationality
D001786:Blood Glucose; D007328:Insulin; D005947:Glucose