Hyperglycemia in Critically Ill Patients: Management and Prognosis
Autor: | Amer Iglica, Ira Tančica, Amina Godinjak, Anes Ajanović, Azra Burekovic, Selma Jusufovic, Adis Kukuljac |
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Jazyk: | angličtina |
Rok vydání: | 2015 |
Předmět: |
Adult
Male medicine.medical_specialty endocrine system diseases medicine.medical_treatment Critical Illness Stress hyperglycemia law.invention Diabetes Complications Young Adult law Diabetes mellitus medicine Humans Insulin Critical illness polyneuropathy Intensive care medicine Aged Mechanical ventilation Aged 80 and over Original Paper Critically ill business.industry nutritional and metabolic diseases General Medicine Middle Aged medicine.disease Prognosis Intensive care unit Intensive Care Units Hyperglycemia Female Complication business |
Zdroj: | Medical Archives |
ISSN: | 1986-5961 0350-199X |
Popis: | Introduction: Hyperglycemia is a common complication of critical illness. Patients in intensive care unit with stress hyperglycemia have significantly higher mortality (31%) compared to patients with previously confirmed diabetes (10%) or normoglycemia (11.3%). Stress hyperglycemia is associated with increased risk of critical illness polyneuropathy (CIP) and prolonged mechanical ventilation. Intensive monitoring and insulin therapy according to the protocol are an important part of the treatment of critically ill patients. Objective: To evaluate the incidence of stress hyperglycemia, complications and outcome in critically ill patients in our Medical intensive care unit. Materials and methods: This study included 100 patients hospitalized in Medical intensive care unit during the period January 2014–March 2015 which were divided into three groups: Diabetes mellitus, stress-hyperglycemia and normoglycemia. During the retrospective-prospective observational clinical investigation the following data was obtained: age, gender, SAPS, admission diagnosis, average daily blood glucose, highest blood glucose level, glycemic variability, vasopressor and corticosteroid therapy, days on mechanical ventilation, total days of hospitalization in Medical intensive care unit, and outcome. Results: Patients with DM treated with a continuous insulin infusion did not have significantly more complications than patients with normoglycemia, unlike patients with stress hyperglycemia, which had more severe prognosis. There was a significant difference between the maximum level of blood glucose in recovered and patients with adverse outcome (p = 0.0277). Glycemic variability (difference between max. and min. blood glucose) was the strongest predictor of adverse outcome. The difference in glycemic variability between the stress-hyperglycemia and normoglycemic group was statistically significant (p = 0.0066). There was no statistically significant difference in duration of mechanical ventilation and total days of hospitalization in the intensive care unit between the groups. Conclusion: Understanding of the objectives of glucose regulation and effective glycemic control is essential for the proper optimization of patient outcomes. |
Databáze: | OpenAIRE |
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