Optimal glycemic control in neurocritical care patients
نویسندگان
چکیده
Currently, the major issue in glycemic control in neurocritical care patients is that tight glycemic control (target range of 80 to 110 mg/dL) using intensive insulin therapy is associated with higher rates of hypoglycemia without an improvement in survival rate. The review by Kramer and colleagues in this issue of Critical Care confirms these data but provides solid evidence about the relationship between hyperglycemia and worsened neurological outcome after acute brain injury. In accordance with the conclusions of Kramer and colleagues, we recommend that a glucose control goal in neurocritical care patients be in the 'moderate' target range (110 to 180 mg/dL). In addition, we recommend adequate nutrition before and during insulin infusion, avoidance of insulin as a bolus, and the use of continuous insulin infusion, beginning with low doses with titration to individual sensitivity. Careful and accurate glycemic monitoring is especially important when insulin is infused.
منابع مشابه
Optimal glycemic control in neurocritical care patients: a systematic review and meta-analysis
INTRODUCTION Hyper- and hypoglycemia are strongly associated with adverse outcomes in critical care. Neurologically injured patients are a unique subgroup, where optimal glycemic targets may differ, such that the findings of clinical trials involving heterogeneous critically ill patients may not apply. METHODS We performed a systematic review and meta-analysis of randomized controlled trials ...
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