Glycemia management in critical care patients

Table 1 Risks related to hypo, hyper glycemia and high blood glucose target range variability

Take home message
Hypoglycemia is clinically relevant, increased mortality and LOS for BGC values < 80 mg/dL
The risk of hypoglycemic episodes is related to: BGC target range; insulin infusion duration
Hyperglycemia is clinically relevant, increased mortality, increased LOS and higher incidence of postoperative infections for BGC values > 181 mg/dL
High glycemia variability and high complexity of glycemic profile are associated with increased mortality rate

BGC: Blood glucose concentration; LOS: Length of stay.

Table 2 Practical tips for blood concentration

Take home message
Avoid injecting insulin boluses, both subcutaneous and intravenous
Avoid infusing high glucose concentration solution
Avoid point of care devices for BGC measurements
Use parenteral nutrition
In ICU patients “Standard”, according to the “state-of-the-art” BGC target range: 140-180 mg/dL “Advanced” BGC target range: 129-145 mg/dL
In trauma patients (without traumatic brain injury): Overall: BGC < 140 mg/dL If aged 41-60 years: 80-110 mg/dL

BGC: Blood glucose concentration; ICU: Intensive care unit