title: Carbohydrate provision in the era of tight glucose control.
abstract: Glycemic control in the critically ill patient has remained a controversial issue over the last decade. Several large trials, with widely varying results, have generated significant interest in defining the optimal target for blood-glucose control necessary for improving care while minimizing morbidity. Nutritional support has evolved into an additional area of critical care where appropriate practices have been associated with improved patient outcomes. Carbohydrate provision can impact blood-glucose levels, and the relationship between nutrition and glucose levels has become more complex in the era of improved glycemic control. This review discusses the controversy surrounding intensive-insulin therapy in the intensive care unit and explores the relationship with nutritional support, both in the enteral and parenteral form. Achieving realistic goals in both carbohydrate provision and glycemic control may improve patient outcome, and are not mutually exclusive practices.
authors: Department of Surgery, University of Louisville, Louisville, KY 40202, USA. Krmill10@gwise.louisville.edu
authors: Keith R
authors: KR
authors: Miller
authors: Christy M
authors: CM
authors: Lawson
authors: Vance L
authors: VL
authors: Smith
authors: Brian G
authors: BG
authors: Harbrecht
references: Life Sci. 2000 Jun 8;67(3):291-300
references: 10983873
references: Br Med J. 1900 Dec 1;2(2083):1558-61
references: 20759298
references: Am J Surg. 2010 Sep;200(3):386-90
references: 20800717
references: N Engl J Med. 2008 Jan 10;358(2):125-39
references: 18184958
references: Ann Thorac Surg. 2008 Jul;86(1):20-7
references: 18573392
references: JPEN J Parenter Enteral Nutr. 2010 Sep-Oct;34(5):549-53
references: 20852185
references: Am Surg. 2010 Dec;76(12):1377-83
references: 21265352
references: Endocrinology. 1983 Aug;113(2):491-6
references: 6307641
references: Crit Care. 2008;12(6):R139
references: 19014427
references: Semin Thorac Cardiovasc Surg. 2006 Winter;18(4):339-45
references: 17395031
references: J Diabetes Sci Technol. 2009 Nov 01;3(6):1302-8
references: 20144384
references: Mayo Clin Proc. 2010 Mar;85(3):217-24
references: 20176928
references: Diabetes Care. 2008 Jun;31(6):1222-3
references: 18332163
references: Br J Surg. 2004 Sep;91(9):1138-45
references: 15449264
references: Br J Surg. 2007 Nov;94(11):1342-50
references: 17902094
references: Chest. 2010 Mar;137(3):544-51
references: 20018803
references: Am J Med Sci. 2007 May;333(5):261-5
references: 17505165
references: N Engl J Med. 2001 Nov 8;345(19):1359-67
references: 11794168
references: Intensive Care Med. 2009 Oct;35(10):1738-48
references: 19636533
references: Crit Care. 2008;12(6):R154
references: 19055829
references: Colorectal Dis. 2006 Sep;8(7):563-9
references: 16919107
references: Crit Care. 2008;12(5):R120
references: 18799004
references: N Engl J Med. 2006 Feb 2;354(5):449-61
references: 16452557
references: J Clin Endocrinol Metab. 2009 Sep;94(9):3163-70
references: 19531590
references: Anesth Analg. 2008 Jul;107(1):51-8
references: 18635467
references: Adv Cardiol. 2008;45:17-43
references: 18230954
references: Crit Care. 2008;12(6):194
references: 19040779
references: Clin Nutr. 2003 Jun;22(3):295-305
references: 12765670
references: Eur J Pharmacol. 1997 Jul 9;330(2-3):185-93
references: 9253952
references: Anesthesiology. 2004 Apr;100(4):861-70
references: 15087621
references: N Engl J Med. 2009 Mar 26;360(13):1283-97
references: 19318384
references: Crit Care. 2008;12(5):R129
references: 18939991
references: Arch Surg. 2009 Oct;144(10):961-9
references: 19841366
references: Mayo Clin Proc. 2004 Aug;79(8):992-1000
references: 15301325
references: Crit Care Med. 2005 Dec;33(12):2778-85
references: 16352960
references: Clin Nutr. 2005 Aug;24(4):502-9
references: 15899538
references: Cochrane Database Syst Rev. 2003;(4):CD004423
references: 14584013
references: JPEN J Parenter Enteral Nutr. 2009 May-Jun;33(3):277-316
references: 19398613
references: Crit Care Med. 2005 Jul;33(7):1624-33
references: 16003073
references: Crit Care Med. 2006 Nov;34(11):2714-8
references: 16943734
references: Mol Med. 2008 Nov-Dec;14(11-12):715-23
references: 19009015
references: Arch Neurol. 2010 Sep;67(9):1123-30
references: 20837858
references: Crit Care. 2009;13(3):R91
references: 19534781
references: Clin Nutr. 2005 Feb;24(1):32-7
references: 15681099
references: Crit Care Resusc. 2006 Dec;8(4):283-8
references: 17227262
references: Crit Care Med. 2008 Dec;36(12):3190-7
references: 18936702