ENDOCRINE CHANGES IN CRITICALLY ILL PATIENTS 

Minerva Endocrinologica 2014 December;39(4):261-71

Copyright © 2014 EDIZIONI MINERVA MEDICA

language: English

Emerging paradigms on glucose management in the intensive care unit

Evans A. S. ¹, Hosseinian L. ¹, Mechanick J. I. ² ✉

¹ Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; ² Division of Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY, USA

Hyperglycemia is common in critical illness and leads to increased morbidity and mortality. Controversy exists whether tight glycemic control via intensive insulin therapy can safely and effectively improve outcomes. In this review article, we will sort through the pertinent evidence base to identify salient, yet emergent, paradigms to guide management. To this end, we will discuss underlying biologic mechanisms relevant to hyperglycemia and insulinization in critical illness, summarize results of major randomized controlled clinical trials for glycemic control in the intensive care unit (ICU), and fill in the gaps with necessary information. We will conclude with specific messages, not only reflecting our own clinical experiences, but amenable to implementation in different ICU settings.