医学
血糖性
重症监护医学
病危
低血糖
重症监护室
重症监护
人口
临床试验
胰岛素
内科学
环境卫生
标识
DOI:10.1080/21548331.2015.1066227
摘要
Since publication of the Normoglycemia in Intensive Care Evaluation – Survival Using Glucose Algorithm Regulation trial in 2009, demonstrating increased 90-day mortality in a large cohort of critically ill patients treated with the intensive, rather than moderate blood glucose (BG) target, enthusiasm has dampened for ‘tight glucose control’ in intensive care units. Nevertheless, a burgeoning literature has clarified limitations of the interventional trials of intensive insulin therapy in the critically ill and explored key clinical aspects of glycemic control in this population. This review provides an overview of the last 6 years of research in this field. Topics include advances in understanding the domains of glycemic control – hyperglycemia, hypoglycemia and glucose variability; the role of diabetic status in modulating the relationship of these domains of control to mortality; the importance of premorbid glucose control in patients with diabetes; the central role that measurement frequency has in determining success in achieving desired BG control and, finally, new data exploring time in targeted BG range, a potentially ‘unifying’ metric.
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