Care of Critically Ill Patients
Our Challenge
During a critical illness, the body’s response to stress can result in hyperglycemia (blood glucose levels of >12 mmol/L), even in patients without diabetes. Uncontrolled hyperglycemia during a stay in the intensive care unit can increase the risk of bloodstream infections, acute renal failure, prolonged inflammation, polyneuropathies, and even death1,2.
Although attempting to control glucose within very strict parameters (4.5 to 6.0 mmol/L) has the potential to cause further harm, more recent research shows optimal levels to target at <10 mmol/L3,4. Maintaining blood glucose levels below this target in critically ill adults requires a careful balance of intravenous insulin and nutrition to ensure levels are controlled but do not fall below hypoglycemic thresholds.
Our Clinical Care Management team is here to support you, as you work toward improving glycemic control in your intensive care unit. Get started with the resources through the links below or contact us today.
References
- Van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in critically ill patients. NEJM. 2001;345 (19): 1359-67
- Van den Berghe G, Wilmer A, Hermans G, et al. Intensive insulin therapy in the medical ICU. NEJM. 2006;354(5) 449-61
- Griesdale DE., de Souza RJ, van Dam RM et al. Intesive insulin therapy and mortality among critically ill patients. A meta-analysis including NICE-SUGAR study data. CMAJ 2009; 180(8): 799-800
- NICE-SUGAR study investigators, Finfer S, Chittock DR Su SY, et al. Intensive versus conventional glucose control in critically ill patients. NEJM. 2009; 360(13): 1283-97
At a Glance
Key Contacts
Dr. Juan Ronco,
Clinical Lead
BC Patient Safety & Quality Council
jronco@bcpsqc.ca
Shari McKeown,
Director, Clinical Improvement
BC Patient Safety & Quality Council
smckeown@bcpsqc.ca
778.477.4440
James L. Watson,
Director, Clinical Innovation
Clinical Consultation and Operational Monitoring Branch
Health Authorities Division/Ministry of Health
james.watson@gov.bc.ca
250.952.2857