Thursday, May 22, 2008

Fluctuations in Glucose Levels Linked to ICU Deaths

Patients who are critically ill often experience elevated glucose (blood sugar) levels. Past studies have shown that there seems to be a link between acute coronary syndrome, mortality and high blood sugar in patients admitted to the ICU. According to a new study, presented at the American Thoracic Society 2008 International Conference, wide variables in glucose levels among critically ill patients may also contribute to higher death rates, complications and longer hospital stays.

The study was presented by Hasan Al-Dorzi, MD, a pulmonary critical care consultant at King AbdulAziz Medical City/King Fahad National Guard Hospital in Riyadh, Saudi Arabia, who said, "We know that at a cellular level...there is evidence of this up-and-down fluctuation of glucose being harmful to cells. We also know from diabetes research that diabetic patients, who have up-and-down fluctuations, even when not in hospital, have a higher incidence of complications”, suggesting once again that current guidelines for managing glucose levels in the ICU should be revisited.

One solution suggested by Dr. Al-Dorzi is to find advances in technology that would link present computerized devices to a rapid insulin infusion system. He says, "If we have devices in the future that allow for continuous monitoring of blood glucose, and we have on hand computerized protocols that can detect changes more rapidly and allow insulin infusion rapidly, we can correct these fluctuations in a short time and improve the outcomes of our patients." Ellen Burnham, MD, assistant professor of medicine at the University of Colorado in Denver suggested during an interview, "Perhaps we can't take a 1-size-fits-all approach to managing blood sugar, and need to tailor our management to each patient and particular condition.” Dr. Burnham admitted that the problem is challenging.

I personally wonder if a renewed focus on nutritional status might also be helpful for better glucose control in critically ill patients.

Source: - From American Thoracic Society (ATS) 2008 International Conference ◦