Improving glycemic control in critically ill patients: Personalized care to mimic the endocrine pancreas

[en] There is considerable physiological and clinical evidence of harm and increased risk of death associated with dysglycemia in critical care. However, glycemic control (GC) currently leads to increased hypoglycemia, independently associated with a greater risk of death. Indeed, recent evidence suggests GC is difficult to safely and effectively achieve for all patients. In this review, leading experts in the field discuss this evidence and relevant data in diabetology, including the artificial pancreas, and suggest how safe, effective GC can be achieved in critically ill patients in ways seeking to mimic normal islet cell function. The review is structured around the specific clinical hurdles of: understanding the patient's metabolic state; designing GC to fit clinical practice, safety, efficacy, and workload; and the need for standardized metrics. These aspects are addressed by reviewing relevant recent advances in science and technology. Finally, we provide a set of concise recommendations to advance the safety, quality, consistency, and clinical uptake of GC in critical care. This review thus presents a roadmap toward better, more personalized metabolic care and improved patient outcomes. © 2018 The Author(s).

Disciplines :

Anesthesia & intensive care

Author, co-author :

Chase, J. G.; University of Canterbury, Department of Mechanical Engineering, Centre for Bio-Engineering, Christchurch, New Zealand

Desaive, Thomas ; Université de Liège - ULiège > Département d'astrophys., géophysique et océanographie (AGO) > Thermodynamique des phénomènes irréversibles

Bohe, J.; Lyon-Sud University Hospital, Medical Intensive Care Unit, Pierre-Bénite, France

Cnop, M.; Université Libre de Bruxelles, ULB Center for Diabetes Research, and Division of Endocrinology, Erasme Hospital, Brussels, Belgium

De Block, C.; Antwerp University Hospital, Department of Endocrinology, Diabetology and Metabolism, Edegem, Belgium

Gunst, J.; KU Leuven, Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, Leuven, Belgium

Hovorka, R.; University of Cambridge Metabolic Research Laboratories, Level 4, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, United Kingdom

Kalfon, P.; Service de Réanimation polyvalente, Hôpital Louis Pasteur, CH de Chartres, Chartres, France

Krinsley, J.; Stamford Hospital, Columbia University College of Physicians and Surgeons, Division of Critical Care, Department of Medicine, Stamford, CT, United States

Renard, E.

Preiser, J.-C.; Erasme Hospital, Université Libre de Bruxelles, Department of Intensive Care, route de Lennik 808, Brussels, Belgium

Language :

English

Title :

Improving glycemic control in critically ill patients: Personalized care to mimic the endocrine pancreas

Publication date :

2018

Journal title :

Critical Care

ISSN :

1364-8535

eISSN :

1466-609X

Publisher :

BioMed Central Ltd.

Volume :

Issue :

Peer reviewed :

Peer Reviewed verified by ORBi

Available on ORBi :

since 27 May 2019

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