Glucose control in critically ill patients

摘要

Opinions regarding the control of blood glucose in critically ill patients have fluctuated dramatically over the past decade, and while our knowledge is far greater than in 2001, many questions remain unanswered.Hyperglycaemia is highly prevalent during critical illness, with 90% of patients treated in intensive care units (ICU) experiencing blood glucose concentrations greater than 6.1 mmol/L. The hypermetabolic 'stress' state is associated with both increased hepatic glucose production and peripheral insulin resistance, which is compounded by the hyperglycaemic effects of treatments, such as corticosteroids, sympathomirnetic agents and glucose containing infusions. During the 1990s, the prevailing opinion was that hyperglycaemia was a normal and potentially beneficial physiological response to critical illness that promoted cellular glucose uptake.