title: [Blood glucose control in critically ill perioperative patients].
abstract: Hyperglycemia is common in critically ill patients with approximately 90% of patients treated in an intensive care unit (ICU) developing blood glucose concentrations greater than 110 mg x dl(-1). Recently the international multicentre NICE-SUGAR study reported increased mortality with adopting intensive glucose control for critically ill patients and recent meta-analyses do not support this approach. Whilst the initial trials in Leuven produced enthusiasm and recommendations for intensive blood glucose control, the results of the NICE-SUGAR study have resulted in the more moderate recommendation to target a blood glucose concentration between 144 and 180 mg x dl(-1). As critical care practitioners paid greater attention to glycemic control it became clear that currently used point-of-care measuring systems are not accurate enough to target tight glucose control. Unresolved issues include whether increased blood glucose variability is inherently harmful and whether even moderate hypoglycemia can be tolerated in the quest for tighter blood glucose control. Until another level I evidence will be available, clinicians would be well advised to hasten slowly and abide by the age-old adage to "first, do no harm".
authors.affiliation: Department of Anesthesiology and Resuscitology, Okayama University Medical School, Okayama 700-8558.
authors.forename: Moritoki
authors.initials: M
authors.lastname: Egi
mesh_terms: D001786:Blood Glucose / Q000032:analysis; D016638:Critical Illness / Q000628:therapy*; D019317:Evidence-Based Medicine; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy*; D059035:Perioperative Period
chemical_list: D001786:Blood Glucose