Carole Ichai , Jean-Charles Preiser , Societe Francaise d'Anesthesie-Reanimation (sfar) and Societe de Reanimation de langue Francaise (srlf). Critical Care 2010, 14:R166doi:10.1186/cc9258. Published: 14 September 2010
Abstract (provisional)
Introduction
The purpose of this research is to provide recommendations for the management of glycemic control in critically ill patients.
Methods
Twenty-one experts issued recommendations related to one of the five pre-defined categories (glucose target, hypoglycemia, carbohydrate intake, monitoring of glycemia, algorithms and protocols), that were scored on a scale to obtain a strong or weak agreement. The GRADE (Grade of Recommendation, Assessment, Development and Evaluation) system was used, with a strong recommendation indicating a clear advantage for an intervention and a weak recommendation indicating that the balance between desirable and undesirable effects of an intervention is not clearly defined.
Results
A glucose target below 10 mmol/L is strongly suggested, using intravenous insulin following a standard protocol, when spontaneous food intake is not possible. Definition of severe hypoglycemia threshold of 2.2 mmol/L is recommended, regardless of the clinical signs. A general unique amount of glucose (enteral/parenteral) to administer for any patient cannot be suggest. Glucose measurements should be performed rather on arterial than venous or capillary samples, using rather central lab or blood gas analysers than point-of-care glucose readers.
Conclusions
Thirty recommendations were obtained with a strong (21) and a weak (9) agreement. Among them, only 15 were graded with a high level of quality of evidence, underlying the necessity to continue clinical studies in order to improve the risk-to-benefit ratio of glucose control.
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Abstract (provisional)
Introduction
The purpose of this research is to provide recommendations for the management of glycemic control in critically ill patients.
Methods
Twenty-one experts issued recommendations related to one of the five pre-defined categories (glucose target, hypoglycemia, carbohydrate intake, monitoring of glycemia, algorithms and protocols), that were scored on a scale to obtain a strong or weak agreement. The GRADE (Grade of Recommendation, Assessment, Development and Evaluation) system was used, with a strong recommendation indicating a clear advantage for an intervention and a weak recommendation indicating that the balance between desirable and undesirable effects of an intervention is not clearly defined.
Results
A glucose target below 10 mmol/L is strongly suggested, using intravenous insulin following a standard protocol, when spontaneous food intake is not possible. Definition of severe hypoglycemia threshold of 2.2 mmol/L is recommended, regardless of the clinical signs. A general unique amount of glucose (enteral/parenteral) to administer for any patient cannot be suggest. Glucose measurements should be performed rather on arterial than venous or capillary samples, using rather central lab or blood gas analysers than point-of-care glucose readers.
Conclusions
Thirty recommendations were obtained with a strong (21) and a weak (9) agreement. Among them, only 15 were graded with a high level of quality of evidence, underlying the necessity to continue clinical studies in order to improve the risk-to-benefit ratio of glucose control.
Weblink here