International recommendations for glucose control in adult non diabetic critically ill patients
1 Medical and Surgical Intensive Care Unit, Saint-Roch Hospital, University of Medicine of Nice, 06000 Nice, France
2 Department of Intensive Care, Erasme University Hospital, 808 route de Lennik, 1070 Brussels, Belgium
3 SFAR - Société Française d'Anesthésie et de Réanimation, 74 Rue Raynouard, 75016 Paris, France
4 SRLF - Société de Réanimation de Langue Française, 48 avenue Claude Vellefaux, 75010 Paris, France
Critical Care 2010, 14:R166 doi:10.1186/cc9258Published: 14 September 2010
The purpose of this research is to provide recommendations for the management of glycemic control in critically ill patients.
Twenty-one experts issued recommendations related to one of the five pre-defined categories (glucose target, hypoglycemia, carbohydrate intake, monitoring of glycemia, algorithms and protocols), that were scored on a scale to obtain a strong or weak agreement. The GRADE (Grade of Recommendation, Assessment, Development and Evaluation) system was used, with a strong recommendation indicating a clear advantage for an intervention and a weak recommendation indicating that the balance between desirable and undesirable effects of an intervention is not clearly defined.
A glucose target of less than 10 mmol/L is strongly suggested, using intravenous insulin following a standard protocol, when spontaneous food intake is not possible. Definition of the severe hypoglycemia threshold of 2.2 mmol/L is recommended, regardless of the clinical signs. A general, unique amount of glucose (enteral/parenteral) to administer for any patient cannot be suggested. Glucose measurements should be performed on arterial rather than venous or capillary samples, using central lab or blood gas analysers rather than point-of-care glucose readers.
Thirty recommendations were obtained with a strong (21) and a weak (9) agreement. Among them, only 15 were graded with a high level of quality of evidence, underlying the necessity to continue clinical studies in order to improve the risk-to-benefit ratio of glucose control.