Tight blood glucose control in ICU patients

Abstract

Introduction: Blood glucose control in patients hospitalized in the ICU requires special attention. Hyperglycemia, a condition that has the potential to increase the risk of morbidity and mortality from various pathologies, is often associated with metabolic disorders in critically ill patients in the ICU. Thus, several randomized studies were conducted to understand whether glycemic control had a significant improvement in the patient's evolution. There is strong evidence of strict glycemic control since 2001, where a study was conducted with 1548 patients showing that there was a significant improvement in the outcome of morbidity and mortality in patients who received intense insulin therapy (IIT) to maintain blood glucose within the normal range: 80-110 mg/dl.  Methods: The present study is a literature review that used the Scielo and Pubmed databases. The article selection period was from 2001-2023 and 10 articles in Portuguese and English were selected to be reviewed. The following health descriptors (DeCS) were used: "hyperglycemia", "UTI", "blood glucose", "glycemic control". Discussion: Hyperglycemia can occur in patients who are not diabetic, usually occurs in critically ill patients in intensive care, and is associated with morbidity and mortality factors. Hyperglycemia in those without a history of diabetes is associated with a worse prognosis and therefore its control must be carried out rigorously.  The discussion about blood glucose control in critically ill patients is currently a matter of debate and there is still no consensus on the subject. The critically ill patient presents several metabolic variations and nuances and thus the glucose control model has also been taking shape, respecting the variability of each patient. Hyperglycemia is caused by constant exposure to stress in the body, in the critically ill patient this relationship varies slightly. Conclusion: Strict blood glucose control should be adopted as basic care for critically ill patients. The consequences and frequency of hyperglycemia are contributing factors to the patient's prognosis.