title: Glycemic control and nutritional strategies in the cardiothoracic surgical intensive care unit--2010: state of the art.
abstract: Patients in the cardiothoracic surgical intensive care unit are generally critically ill and undergoing a systemic inflammatory response to cardiopulmonary bypass, ischemia/reperfusion, and hypothermia. This presents several metabolic challenges: hyperglycemia in need of intensive insulin therapy, catabolism, and uncertain gastrointestinal tract function in need of nutritional strategies. Currently, there are controversies surrounding the standard use of intensive insulin therapy and appropriate glycemic targets as well as the use of early enteral nutrition ± parenteral nutrition. In this review, an approach for intensive metabolic support in the cardiothoracic surgical intensive care unit is presented incorporating the most recent clinical evidence. This approach advocates an IIT blood glucose target of 80-110 mg/dL if, it can be implemented safely, with early nutrition support (using parenteral nutrition as needed) to prevent a critical energy debt.
authors.affiliation: Division of Endocrinology, Diabetes and Bone Disease, Mount Sinai School of Medicine, New York, New York, USA. jmechanick@aol.com
authors.forename: Jeffrey I
authors.initials: JI
authors.lastname: Mechanick
authors.forename: Corey
authors.initials: C
authors.lastname: Scurlock
mesh_terms: D001786:Blood Glucose / Q000378:metabolism*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D016638:Critical Illness / Q000628:therapy*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D007362:Intensive Care Units; D009752:Nutritional Status; D018529:Nutritional Support; D018570:Risk Assessment; D019616:Thoracic Surgical Procedures / Q000009:adverse effects* / Q000379:methods
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin