Hyperglycemia in critically ill patients

its evidence based presentation in hyperglycemia in critically care

1. Dr. Santosh Kumar Bhaskar Professor Anaesthesiology HYPERGLYCEMIA IN CRITICALLY ILL PATIENTS

2. Definition "transient hyperglycaemia during acute illness –usually restricted to patients without prior evidence of diabetes with reversion to normal after discharge.“

3. Hyperglycaemia which is Transient Reversible Associated with severe acute illness In a patient previously not diabetic

4. Is hyperglycemia bad ?

5. Hyperglycaemia - whether on admission or longitudinally - is an negative prognostic in several patient groups: Trauma Severe head injury Subarachnoid haemorrhage Myocardial infarction Sepsis Stroke

6. Evidence regarding glycaemic control in the critically ill 1995: the DIGAMI trial

7. Evidence regarding glycaemic control in the critically ill 2001: The Leuven Intensive Insulin Therapy Trial

8. Post study commentary The goalposts for what should be an acceptable BSl had shifed worldwide; everybody was obsessively micromanaging their insulin pumps within a narrow range of 4.4-6.1 mmol /L . However, not all was well. European trials of this protocol did not find the expected benefit, and in fact had to stop prematurely because too many patients were having hypoglycaemic episodes.

9. Evidence regarding glycaemic control in the critically ill 2009: NICE-SUGAR

10. A post hoc analysis of the NICE-SUGAR data was published in 2012, digging deeper and unearthing the prevalence of hypoglycaemia . Patients who had episodes of hypoglycaemia were twice as likely to die, and patients with "intensive" BSL control were ten times as likely to have a hypoglycaemic episode compared to "relaxed" controls. The authors conclude that hypoglycaemia and death had a dose-response relationship, and that this relationship was strongest for patients with "distributive shock".

11. Evidence regarding glycaemic control in the critically ill 2014: Most recent opinions

12. Evidence regarding glycaemic control in the critically ill Feasibility of closed loop system

13. In summary... A recent review by Mesotten et al (2015) makes recommendation which is " not based on findings from randomised controlled trials, but merely represents a very common, pragmatic approach by physicians at the bedside ". Keep their BSL between 4 and 8 if you can . Definitely keep it under 10 Definitely keep it above 2.2

14. Thanks