[Insulin infusion for critically ill patients].

BACKGROUND

Stress, acute illness and surgery are known to increase blood sugar. Hyperglycaemia in critically ill patients is associated with increased mortality irrespective of diabetes status. The effect of treating critically ill patients with insulin infusions has been assessed in many randomised trials in recent years. Possible mechanisms related to hyperglycaemia and the effects of insulin have also been studied.

MATERIAL AND METHODS

The present review is based on a systematic Medline search, references in key articles, and our personal clinical experience.

RESULTS

The effect of reducing blood glucose to normal levels is best documented in patients with myocardial infarction and in those receiving intensive care. Insulin therapy should be considered when plasma glucose levels exceed 8 mmol/L; the treatment target is 4-6 mmol/L. There is a low risk of serious hypoglycaemia according to our experience, but systematic monitoring of blood glucose is important.

INTERPRETATION

Insulin therapy is an inexpensive and safe way to improve outcome in critically ill patients. Insulin infusions should therefore be used more to treat hyperglycaemia in critically ill hospitalized patients, especially in coronary care- and intensive care units.