The question of hyperglycemia in the critically ill and how to address it has been the topic of considerable study over the years.
There have been several attempts to try to quantify the best target glucose levels in critically ill patients. This is still a moving target, but a recent study sheds some light on the effect of different levels of hyperglycemia and the types of patients who are particularly vulnerable.
This is a retrospective cohort study whic reviewed 259,000 ICU admissions over a three year period at 173 separate sites. Their findings were as follows:
Compared with normoglycemic patients, the adjusted odds for mean glucose 111-145, 146-199, 200-300, and >300 was 1.31, 1.82, 2.13 and 2.85 respectively.
There is a clear association between the adjusted odds of mortality related to hyperglycemia in patients with AMI, arrhythmia, unstable angina, pulmonary embolism, pneumonia and gastrointestinal bleed.
Hyperglycemia associated with increased mortality was independent of type of ICU, length of stay and/or pre-existing diabetes.
So, even though we have not come to solid conclusions about how far down to keep the glucose levels down, it makes sense to pay particular attention and be more vigilant of the blood glucose levels, especially in the higher-risk patients listed above.
References
Flaciglia M, Freyberg RW et al: Hyperglycemia-related mortality in critically ill patients varies with admission diagnosis. Crit Care Med 2009;37:3001-3009
