Over the last decade, the approach to clinical management of blood glucose concentration (BGC) in critical care patients has dramatically changed. In this editorial, the risks related to hypo, hyperglycemia and high B...Over the last decade, the approach to clinical management of blood glucose concentration (BGC) in critical care patients has dramatically changed. In this editorial, the risks related to hypo, hyperglycemia and high BGC variability, optimal BGC target range and BGC monitoring devices for patients in the intensive care unit (ICU) will be discussed. Hypoglycemia has an increased risk of death, even after the occurrence of a single episode of mild hypoglycemia (BGC < 80 mg/dL), and it is also associated with an increase in the ICU length of stay, the major determinant of ICU costs. Hyperglycemia (with a threshold value of 180 mg/dL) is associated with an increased risk of death, longer length of stay and higher infective morbidity in ICU patients. In ICU patients, insulin infusion aimed at maintaining BGC within a 140-180 mg/dL target range (NICE-SUGAR protocol) is considered to be the state-of-the-art. Recent evidence suggests that a lower BGC target range (129-145 mg/dL) is safe and associated with lower mortality. In trauma patients without traumatic brain injury, tight BGC (target < 110 mg/dL) might be associated with lower mortality. Safe BGC targeting and estimation of optimal insulin dose titration should include an adequate nutrition protocol, the length of insulin infusion and the change in insulin sensitivity over time. Continuous glucose monitoring devices that provide accurate measurement can contribute to minimizing the risk of hypoglycemia and improve insulin titration. In conclusion, in ICU patients, safe and effective glycemia management is based on accurate glycemia monitoring and achievement of the optimal BGC target range by using insulin titration, along with an adequate nutritional protocol.展开更多
目的分析入住神经内科重症监护室(NICU)的脑卒中患者高血糖控制状况并探讨血糖水平与死亡风险的关系。方法纳入2017年7月~2018年12月入住NICU时发生高血糖的脑卒中患者进行回顾性分析,将其分为死亡组和存活组,比较两组之间血糖控制状况...目的分析入住神经内科重症监护室(NICU)的脑卒中患者高血糖控制状况并探讨血糖水平与死亡风险的关系。方法纳入2017年7月~2018年12月入住NICU时发生高血糖的脑卒中患者进行回顾性分析,将其分为死亡组和存活组,比较两组之间血糖控制状况的差异,及其与死亡风险的关系。结果共纳入395例高血糖患者,其中死亡组22例,存活组373例。与存活组相比,死亡组的平均年龄(岁)(78.86±11.13 vs 67.81±16.04,P<0.01)、APACHEⅡ评分(分)(12.9±3.92 vs 10.78±3.01,P<0.05)、平均血糖值(mmol/L)(12.93±5.49 vs 10.7±4.56,P<0.01)、高血糖发生率(血糖>7.8 mmol/L)(83.31%vs 68.55%,P<0.01)、严重高血糖发生率(血糖>13.9 mmol/L)(36.01%vs 21.65%,P<0.01)、临床显著低血糖发生率(血糖<3.0 mmol/L)(0.28%vs 0.18%,P<0.05)、血糖漂移度(mmol/L)(4.20±1.44 vs 2.84±1.44,P<0.01)、最大血糖波动幅度(mmol/L)(17.34±8.48 vs 11.22±6.45,P<0.01)均明显增加,而目标血糖达标率(62.47%vs 78.07%,P<0.01)明显降低。多因素分析显示年龄(OR=1.083)、APACHEⅡ评分(OR=1.282)、平均血糖值(OR=1.424)是脑卒中合并高血糖患者死亡的独立危险因素。结论NICU住院脑卒中患者高血糖发生率高,血糖波动幅度大,尤其在死亡患者中更为明显,应重视血糖管理;其年龄、APACHEⅡ评分、平均血糖水平可能是死亡率增加的独立危险因素。展开更多
文摘Over the last decade, the approach to clinical management of blood glucose concentration (BGC) in critical care patients has dramatically changed. In this editorial, the risks related to hypo, hyperglycemia and high BGC variability, optimal BGC target range and BGC monitoring devices for patients in the intensive care unit (ICU) will be discussed. Hypoglycemia has an increased risk of death, even after the occurrence of a single episode of mild hypoglycemia (BGC < 80 mg/dL), and it is also associated with an increase in the ICU length of stay, the major determinant of ICU costs. Hyperglycemia (with a threshold value of 180 mg/dL) is associated with an increased risk of death, longer length of stay and higher infective morbidity in ICU patients. In ICU patients, insulin infusion aimed at maintaining BGC within a 140-180 mg/dL target range (NICE-SUGAR protocol) is considered to be the state-of-the-art. Recent evidence suggests that a lower BGC target range (129-145 mg/dL) is safe and associated with lower mortality. In trauma patients without traumatic brain injury, tight BGC (target < 110 mg/dL) might be associated with lower mortality. Safe BGC targeting and estimation of optimal insulin dose titration should include an adequate nutrition protocol, the length of insulin infusion and the change in insulin sensitivity over time. Continuous glucose monitoring devices that provide accurate measurement can contribute to minimizing the risk of hypoglycemia and improve insulin titration. In conclusion, in ICU patients, safe and effective glycemia management is based on accurate glycemia monitoring and achievement of the optimal BGC target range by using insulin titration, along with an adequate nutritional protocol.
文摘目的分析入住神经内科重症监护室(NICU)的脑卒中患者高血糖控制状况并探讨血糖水平与死亡风险的关系。方法纳入2017年7月~2018年12月入住NICU时发生高血糖的脑卒中患者进行回顾性分析,将其分为死亡组和存活组,比较两组之间血糖控制状况的差异,及其与死亡风险的关系。结果共纳入395例高血糖患者,其中死亡组22例,存活组373例。与存活组相比,死亡组的平均年龄(岁)(78.86±11.13 vs 67.81±16.04,P<0.01)、APACHEⅡ评分(分)(12.9±3.92 vs 10.78±3.01,P<0.05)、平均血糖值(mmol/L)(12.93±5.49 vs 10.7±4.56,P<0.01)、高血糖发生率(血糖>7.8 mmol/L)(83.31%vs 68.55%,P<0.01)、严重高血糖发生率(血糖>13.9 mmol/L)(36.01%vs 21.65%,P<0.01)、临床显著低血糖发生率(血糖<3.0 mmol/L)(0.28%vs 0.18%,P<0.05)、血糖漂移度(mmol/L)(4.20±1.44 vs 2.84±1.44,P<0.01)、最大血糖波动幅度(mmol/L)(17.34±8.48 vs 11.22±6.45,P<0.01)均明显增加,而目标血糖达标率(62.47%vs 78.07%,P<0.01)明显降低。多因素分析显示年龄(OR=1.083)、APACHEⅡ评分(OR=1.282)、平均血糖值(OR=1.424)是脑卒中合并高血糖患者死亡的独立危险因素。结论NICU住院脑卒中患者高血糖发生率高,血糖波动幅度大,尤其在死亡患者中更为明显,应重视血糖管理;其年龄、APACHEⅡ评分、平均血糖水平可能是死亡率增加的独立危险因素。
