Insulin therapy in the intensive care unit should be targeted to maintain blood glucose between 4.4 mmol/l and 6.1 mmol/l

Berghe, Greet Van den

doi:10.1007/s00125-007-0878-7

Cited by 40 publications

(16 citation statements)

References 30 publications

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“…83,98 Traditionally, a combination of a thyroid hormone, steroids, vasopressin, and insulin has been used. 6 Today, insulin therapy and blood sugar control is implemented in intensive care, [107][108][109] and a majority of organ donors receive insulin already before brain death. They also receive metylprednisolone to attenuate immune responses (to be discussed later), and vasopressin is often already part of the vasopressor therapy.…”

Section: Hemodynamic Managementmentioning

confidence: 99%

Brain death and its implications for management of the potential organ donor

Bugge

2009

Acta Anaesthesiol Scand

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The systemic physiologic changes that occur during and after brain death affect all organs suitable for transplantation. Major changes occur in the cardiovascular, pulmonary, endocrine, and immunological systems, and, if untreated may soon result in cardiovascular collapse and somatic death. Understanding these complex physiologic changes is mandatory for developing effective strategies for donor resuscitation and management in such a way that the functional integrity of potentially transplantable organs is maintained. This review elucidates these physiological changes and their consequences, and based on these consequences the rationale behind current medical management of brain-dead organ donors is discussed.

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Section: Hemodynamic Managementmentioning

confidence: 99%

Brain death and its implications for management of the potential organ donor

Bugge

2009

Acta Anaesthesiol Scand

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“…Nevertheless, Dr Van den Berghe [1] and Dr Miles and colleagues [2] have provided concise and important viewpoints on this topic. Both are worthy of careful study as a guide to individual and institutional soul-searching regarding the implementation of guidelines on inpatient management of hyperglycaemia [3,4].…”

Section: Icu Intensive Care Unitmentioning

confidence: 99%

“…That is a matter of both interpretation and perspective. Van den Berghe provides a predictable and exceptionally rational argument for a target glucose level of ≤6.1 mmol/l [1]; she led the team that conducted the studies and demonstrated benefits at the centre in Leuven. Miles and colleagues suggest that the benefits observed in Leuven could be an artefact of the process of care and may not translate faithfully to other settings; admittedly, his assertions are hypotheses and unproven [2].…”

Section: Icu Intensive Care Unitmentioning

confidence: 99%

A dead heat: target normal glucose levels in the intensive care unit—but with caution

Buse

2008

Diabetologia

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“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14] In 2008, Van den Berghe proposed the need for accurate, continuous blood glucose monitoring devices in the ICU to avoid hypoglycemia caused by IIT, and suggested the use of closed-loop systems for computer-assisted blood glucose control. 15 This review considers the benefi ts and requirements of tight glycemic control in surgery, with a focus on postoperative infection control. We conclude that tight perioperative glycemic control using a closed-loop artifi cial endocrine pancreas system would increase the safety of IIT without inducing hypoglycemia.…”

Section: Introductionmentioning

confidence: 99%

Tight perioperative glycemic control using an artificial endocrine pancreas

2009

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Van den Berghe et al. reported in 2001 that tight glycemic control (maintaining blood glucose levels at 80-110 mg/dl) improved morbidity and mortality in the surgical intensive care unit. This method was termed intensive insulin therapy (IIT), and it is now being adopted worldwide for perioperative care. Recent evidence has suggested that perioperative hyperglycemia significantly contributes to the development of postoperative infection (POI). Many professional societies therefore now recommend IIT over conventional standard glycemic control measures for critically ill adult patients to minimize infectious complications. However, IIT carries a risk of inducing hypoglycemia, which is linked to serious neurological events. We recently demonstrated that achieving perioperative tight glycemic control using an artificial endocrine pancreas for surgical patients was a safe and effective method for decreasing the incidence of POI without increasing the risk of hypoglycemia. We herein review the benefits and requirements of tight glycemic control in surgery, with a focus on infection control. Strict perioperative glycemic control using a closed-loop artificial endocrine pancreas system is recommended for safe and effective performance of IIT.

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Insulin therapy in the intensive care unit should be targeted to maintain blood glucose between 4.4 mmol/l and 6.1 mmol/l

Cited by 40 publications

References 30 publications

Brain death and its implications for management of the potential organ donor

Brain death and its implications for management of the potential organ donor

A dead heat: target normal glucose levels in the intensive care unit—but with caution

Tight perioperative glycemic control using an artificial endocrine pancreas

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