Glycemic control in critically ill surgical patients: risks and benefits

Mukherjee, Kaushik; Albaugh, Vance L.; Richards, Justin E.; Rumbaugh, Kelli; May, Addison K.

doi:10.2147/oas.s50416

Cited by 4 publications

(2 citation statements)

References 135 publications

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“…23 The consequences of poor glycemic control in the ICU are well known, with hypoglycemia, hyperglycemia, and large variations in blood glucose levels leading to adverse patient outcomes. 61 These risks are increased in pregnancy, where adverse maternal and fetal outcomes including miscarriage, preterm labor, perineal tears, operative delivery, and neonatal ICU admissions are known to occur at a higher rate when gestational diabetes is not adequately managed. 62 Despite the known risks, there is insufficient evidence to recommend specific targets for glycemic control in critically ill pregnant patients.…”

Section: Norepinephrinementioning

confidence: 99%

Caring for two in the ICU: Pharmacotherapy in the critically ill pregnant patient

et al. 2023

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Safe and thoughtful medication management of pregnant patients requiring intensive care unit (ICU) level of care is key to optimizing outcomes for both mother and fetus. Pregnancy induces physiologic alterations that closely mirror the changes expected in a critically ill patient. These changes can be predictable depending on the gestational age and trimester and will directly impact the pharmacokinetic profile of medications commonly used in the ICU; examples include decreased gastric emptying, increased blood and plasma volume, increased glomerular filtration, and increased cardiac output. When pregnant patients require ICU care, the resulting impact on drug absorption, distribution, metabolism, and elimination can be difficult to predict. In addition, there are many nuances of medication metabolism and interface with the placental barrier that should be considered when selecting pharmacotherapy for the pregnant patient. Critical care clinicians need to be aware of medication interactions with the placenta and weigh the risk versus benefit profile of medication use in this patient population. Obstetric critical care admissions have increased over the years, especially during the coronavirus waves. Therefore, understanding the interplay between pregnancy and critical illness to optimize pharmacotherapy selection is crucial to improving health outcomes of mother and fetus. This review highlights pharmacotherapy considerations in the pregnant ICU patient for the following topics: physiologic alterations, categorizing medication risk, supportive care, sepsis, cardiogenic shock, acute respiratory distress syndrome, and venous thromboembolism.

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Section: Norepinephrinementioning

confidence: 99%

Caring for two in the ICU: Pharmacotherapy in the critically ill pregnant patient

et al. 2023

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“…1 , 4 The IR poses a significant mortality risk even after adjustment for acute critical illness in diabetic or nondiabetic patients. 5 …”

Section: Introductionmentioning

confidence: 99%

Quantifying the Homeostatic Model Assessment of Insulin Resistance to Predict Mortality in Multi-organ Dysfunction Syndrome

Kant¹,

Naithani²,

Jain³

et al. 2021

Indian Journal of Critical Care Medicine

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A bstract Background Insulin resistance is an integral component of a multi-organ dysfunction syndrome (MODS) associated with increased mortality. We determined a cutoff value for the homeostatic model assessment of insulin resistance (HOMA-IR) during an ICU admission that could predict 28-day mortality of nondiabetic MODS patients. Materials and methods In this prospective, outcome assessor blinded cohort design, we evaluated 82 such patients for fasting blood glucose (FBG)/insulin levels (FIL) during an ICU admission and followed their outcome for 28 days. The primary outcome variable was the HOMA-IR score calculated from the above variables. The statistical tool included receiver operating characteristic curve, Youden index, and correlation and regression analysis. Results Overall, 38 patients succumbed to their illness. The optimal cutoff value for HOMA-IR was ≥1.61 (area under curve: 0.684, sensitivity: 36.8%, specificity: 95.5%). The 28-day survival was significantly lower ( p = 0.001) at HOMA-IR threshold ≥1.61 (odds ratio: 12.25, hazard ratio: 2.98). The mean HOMA-IR among survivors vs nonsurvivors was 0.76 ± 0.61 and 1.38 ± 1.14, respectively ( p = 0.004). Except for FIL and FBG, HOMA-IR values did not correlate with any other baseline or outcome parameters (demographics, APACHE II/sequential organ failure assessment score, vasopressor needs, or ICU/hospital stay). On comparing these parameters across the HOMA-IR threshold, only FIL and the hospital stay varied significantly. Most of the outcome parameters, however, varied significantly among nonsurvivors vs survivors. Conclusion The HOMA-IR is a significant predictor of mortality in MODS. Its cutoff value may assist in determining a reference range for critically ill patients. Its routine use in the light of other disease severity scores may serve in their better prognostication. How to cite this article Sama S, Jain G, Kant R, Bhadoria AS, Naithani M, Kumar A. Quantifying the Homeostatic Model Assessment of Insulin Resistance to Predict Mortality in Multi-organ Dysfunction Syndrome. Indian J Crit Care Med 2021;25(12):1364–1369.

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Hypoglycemia Reduction Strategies in the ICU

Braithwaite¹,

Bavda

Idrees

et al. 2017

Curr Diab Rep

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Hypoglycemia in the ICU has been associated with increased mortality in a number of studies. Insulin dosing and glucose monitoring rules, response to impending hypoglycemia, use of computerization, and attention to modifiable factors extrinsic to insulin algorithms may affect the risk for hypoglycemia. Recurring use of intravenous (IV) bolus doses of insulin in insulin-resistant cases may reduce reliance upon higher IV infusion rates. In order to reduce the risk for hypoglycemia in the ICU, caregivers should define responses to interruption of continuous carbohydrate exposure, incorporate transitioning strategies upon initiation and interruption of IV insulin, define modifications of antihyperglycemic therapy in the presence of worsening renal function or chronic kidney disease, and anticipate the effects traceable to other medications and substances. Institutional and system-wide quality improvement efforts should assign priority to hypoglycemia prevention.

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Glycemic control in critically ill surgical patients: risks and benefits

Cited by 4 publications

References 135 publications

Caring for two in the ICU: Pharmacotherapy in the critically ill pregnant patient

Caring for two in the ICU: Pharmacotherapy in the critically ill pregnant patient

Quantifying the Homeostatic Model Assessment of Insulin Resistance to Predict Mortality in Multi-organ Dysfunction Syndrome

Hypoglycemia Reduction Strategies in the ICU

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