Tight blood glucose control a recommendation applicable to any critically ill patient 英文参考文献.docVIP

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Tight blood glucose control a recommendation applicable to any critically ill patient 英文参考文献.doc

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Tight blood glucose control a recommendation applicable to any critically ill patient 英文参考文献

Available online /content/8/6/427 Commentary Tight blood glucose control: a recommendation applicable to any critically ill patient? Philippe Devos1 and Jean-Charles Preiser2 1Resident, Department of Intensive Care, Centre Hospitalier Universitaire du Sart Tilman, Liege, Belgium 2Clinical Director, Department of Intensive Care, Centre Hospitalier Universitaire du Sart Tilman, Liege, Belgium Corresponding author: Jean-Charles Preiser, Jean-Charles.Preiser@chu.ulg.ac.be Published online: 27 October 2004 Critical Care 2004, 8:427-429 (DOI 10.1186/cc2989) This article is online at /content/8/6/427 ? 2004 BioMed Central Ltd Related to Research by Vriesendorp et al., see page 513 Abstract The issue of tight glucose control with intensive insulin therapy in critically ill patients remains controversial. Although compelling evidence supports this strategy in postoperative patients who have undergone cardiac surgery, the use of tight glucose control has been challenged in other situations, including in medical critically ill patients and in those who have undergone non-cardiac surgery. Similarly, the mechanisms that underlie the effects of high-dose insulin are not fully elucidated. These arguments emphasize the need to study the effects of tight glucose control in a large heterogeneous cohort of intensive care unit patients. Keywords cardiac surgery, critically ill, hyperglycemia, insulin, metabolism Until the end of the past millenium, relatively little attention was given to control of blood sugar levels. In critically ill patients, hyperglycaemia was considered to be physiological because it results from the metabolic and hormonal changes that accompany the stress response to injury. In most intensive care units (ICUs), blood sugar was checked every 4–6 hours and hyperglycaemia (defined as blood sugar levels 10–12 mmol/l [180–216 mg/dl]) was corrected by subcutaneous or intravenous insulin. The presence of pre-existing diabetes mellit