Experimental and clinical evidences for glucose control in intensive care: is infused glucose the key point for study interpretation?
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- 作者：Aur茅lien Mazeraud (31) (32)
Andrea Polito (31) (33) (34)
Djillali Annane (33) (34)
31. Institut Pasteur ; Human Histopathology and Animal Models ; Pr Chretien F ; 28 ; rue du docteur Roux ; 75015 ; Paris ; France
32. Universit茅 Paris Descartes Sorbonne Paris Cit茅 ; Institut Pasteur ; rue du Dr Roux ; 75015 ; Paris ; France
33. Medical and Surgical Intensive Care Unit ; CHU Raymond Poincar茅 (AP-HP) ; University of Versailles Saint Quentin en Yvelines ; 104 boulevard Raymond Poincar茅 ; 92380 ; Garches ; France
34. Universit茅 de Versailles Saint-Quentin en Yvellines ; 55 Avenue de Paris ; 78000 ; Versailles ; France - 刊名：Critical Care
- 出版年：2014
- 出版时间：August 2014
- 年：2014
- 卷：18
- 期：4
- 全文大小：345 KB
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- 出版者：BioMed Central
- ISSN：1364-8535
文摘
Stress-induced hyperglycemia has been considered an adaptive mechanism to stress up to the first intensive insulin therapy trial, which showed a 34% reduction in relative risk of in-hospital mortality when normalizing blood glucose levels. Further trials had conflicting results and, at present, stress-induced hyperglycemia management remains non-consensual. These findings could be explained by discrepancies in trials, notably regarding the approach to treat hyperglycemia: high versus restrictive caloric intake. Stress-induced hyperglycemia is a frequent complication during intensive care unit stay and is associated with a higher mortality. It results from an imbalance between insulin and counter-regulatory hormones, increased neoglucogenesis, and the cytokine-induced insulin-resistant state of tissues. In this review, we summarize detrimental effects of hyperglycemia on organs in the critically ill (peripheric and central nervous, liver, immune system, kidney, and cardiovascular system). Finally, we show clinical and experimental evidence of potential benefits from glucose and insulin administration, notably on metabolism, immunity, and the cardiovascular system.