Hiperglucemia de estrés y su control con insulina en el paciente crítico: evidencia actual / Stress hyperglycemia and its control with insulin in critically ill patients. Current evidence
Med. intensiva (Madr., Ed. impr.)
; 34(4): 273-281, mayo 2010.
Article
in Spanish
| IBECS
| ID: ibc-80826
Responsible library:
ES1.1
Localization: BNCS
RESUMEN
Objetivo:
Analizar la evidencia actual sobre el control de la glucemia con insulina en el paciente crítico. La hiperglucemia de estrés incrementa la morbimortalidad en el paciente crítico y se ha reconocido a la variabilidad de la glucemia como un predictor independiente de mortalidad. Inicialmente, los estudios Leuven han demostrado que el control estricto de la glucemia es capaz de reducir la mortalidad en pacientes críticos médicos y quirúrgicos. Sin embargo, esta estrategia terapéutica incrementa de modo significativo la incidencia de hipoglucemia grave. Recientemente, se han publicado los estudios Efficacy of Volume Substitution and Insulin Therapy in Severe Sepsis, GluControl y Normoglycemia in Intensive Care Evaluation and Survival Using Glucose Algorithm Regulation, los que han demostrado que el control estricto de la glucemia incrementa la mortalidad y la incidencia de hipoglucemia grave. Asimismo, un reciente metaanálisis indica que el control estricto de la glucemia podría ser beneficioso en pacientes críticos quirúrgicos. Futuras investigaciones deberían ser capaces de responder algunos interrogantes importantes surgidos a partir de los diferentes estudios existentes (AU)ABSTRACT
Objective:
To analyze the current evidence on glycemic control with insulin therapy in the critically ill. Recentfindings:
Stress hyperglycemia in critically ill patients has been associated with increased morbidity and mortality. Furthermore, current evidence suggests that glucose variability has a predictive value for hospital mortality. Initially, the Leuven studies showed that intensive insulin therapy was capable of reducing the mortality among surgical and medical ICU patients. Nevertheless, this strategy significantly increases the incidence of severe hypoglycemia. Three important trials on glucose control have been published recently the VISEP, the Glucontrol study and the NICE-SUGAR. They have shown that strict control of glycemia is associated with a higher incidence of mortality and severe hypoglycemia. Furthermore, according to a recent meta-analysis, intensive insulin therapy may be beneficial for patients admitted to a surgical ICU. Further studies should be able to address some queries about these results on glycemic control in the critically ill (AU)
Full text:
Available
Collection:
National databases
/
Spain
Health context:
Sustainable Health Agenda for the Americas
/
SDG3 - Target 3.4 Reduce premature mortality due to noncommunicable diseases
Health problem:
Goal 7: Evidence and knowledge in health
/
Endocrine System Diseases
Database:
IBECS
Main subject:
Hyperglycemia
/
Hypoglycemic Agents
/
Insulin
Type of study:
Prognostic study
Limits:
Humans
Language:
Spanish
Journal:
Med. intensiva (Madr., Ed. impr.)
Year:
2010
Document type:
Article
Institution/Affiliation country:
Facultad de Medicina-UDELAR/Uruguay