Management of hyperglycemia in Critical Care- A comprehensive Review.
Abstract
Hyperglycemia is a common occurrence in critically ill patients and is associated with prolonged hospital stays, higher rates of infection, and increased mortality. Effective management of hyperglycemia in critical care settings is paramount. Several studies and metanalyses consistently highlight hyperglycemia as an indicator of illness severity in these patients. Studies recommend intensive insulin therapy for managing hyperglycemia in critically ill patients, irrespective of their diabetes status. Given that glycemic variability and hypoglycemia can exacerbate the patient's condition, monitoring tools for these parameters are essential in critical care settings. Insulin therapy should strive to minimize glycemic variability and avoid hypoglycemia. Adequate nutritional support is crucial, with evidence supporting enteral nutrition over parenteral nutrition due to its lower infection and mortality risks. Some patients may transition from intravenous to subcutaneous insulin, preferring a basal-bolus insulin regimen over a sliding-scale insulin regimen. Establishing appropriate glycemic targets and thresholds for initiating insulin therapy is essential for managing hyperglycemia in these patients. Continuous blood glucose monitoring and appropriate medical nutrition therapy can significantly enhance patient outcomes.
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