Glycemic management in critically ill patients

Table 1 Summary of recommendations for glycemic management

Recommendations	Ref.
In operative patients including trauma, cardiac, and elective surgical patients, it is advised to start a fast acting insulin regimen in the emergency room and perioperatively whenever applicable	[11,32,55]
In trauma patients, glucose control with a target of 100-150 md/dL is reasonable and most important through the first week of hospitalization	[57,61,62]
In elective surgical patients, glucose control with a target of less than 130 mg/dL is advised perioperatively	[32,53]
In patient who will receive parenteral nutrition, intensive insulin therapy is recommended in anticipation of feeding and especially within the first 24 h of initiation	[34,37,42,45]
In patients receiving hypocaloric feeding or with interruption of enteral feeding, less strict glucose control is recommended	[1,11,45]
The rate of hypoglycemia should be a widely adopted quality control parameter. Elevated rates of hypoglycemia should prompt corrective action and changes in policy as needed	[1,8,9,63]
It is important to avoid excursions in glucose levels by titrating insulin treatment conscientiously, especially in diabetic patients, in trauma, and in surgical patients	[61,66,68,69]
Frequent glucose monitoring is advised. To prevent increasing clinician workload, continuous glucose monitoring may be indicated	[64,65,71,72]
Unexplained rises or falls in glucose levels may be a sign of worsening clinical status or infection	[56,60]