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Semin Respir Crit Care Med 2019; 40(05): 571-579
DOI: 10.1055/s-0039-1697603
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Long and Winding Road to Personalized Glycemic Control in the Intensive Care Unit

Mayanka Tickoo
1   Section of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
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Publication History

Publication Date:
11 December 2019 (online)

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Abstract

In the critically ill adult, dysglycemia is a marker of disease severity and is associated with worse clinical outcomes. Close monitoring of glucose and use of insulin in critically ill patients have been done for more than 2 decades, but the appropriate target glycemic range in critically ill patients remains controversial. Physiological stress response, levels of inflammatory cytokines, nutritional intake, and level of mobility affect glycemic control, and a more personalized approach to patients with dysglycemia is warranted in critically ill intensive care unit (ICU) patients. We discuss the pathophysiology and downstream effects of altered glycemic response in critical illness, management of glycemic control in the ICU, and future strategies toward personalization of critical care glycemic management.

Keywords

hyperglycemia - hypoglycemia - glycemic variability - critical illness - insulin

Disclosures

None.


 

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