Division of Critical Care, Department of Medicine, Stamford Hospital, Columbia University College of Physicians and Surgeons, Stamford, CT, 06902, USA.
Department of Mechanical Engineering, Centre for Bio-Engineering, University of Canterbury, Christchurch, 8140, New Zealand.
Crit Care. 2017 Jul 31;21(1):197. doi: 10.1186/s13054-017-1784-0.
Glucose management in intensive care unit (ICU) patients has been a matter of debate for almost two decades. Compared to intermittent monitoring systems, continuous glucose monitoring (CGM) can offer benefit in the prevention of severe hyperglycemia and hypoglycemia by enabling insulin infusions to be adjusted more rapidly and potentially more accurately because trends in glucose concentrations can be more readily identified. Increasingly, it is apparent that a single glucose target/range may not be optimal for all patients at all times and, as with many other aspects of critical care patient management, a personalized approach to glucose control may be more appropriate. Here we consider some of the evidence supporting different glucose targets in various groups of patients, focusing on those with and without diabetes and neurological ICU patients. We also discuss some of the reasons why, despite evidence of benefit, CGM devices are still not widely employed in the ICU and propose areas of research needed to help move CGM from the research arena to routine clinical use.
在重症监护病房（ICU）患者中进行血糖管理已经争论了近二十年。与间歇性监测系统相比，连续血糖监测（CGM）可以通过更快速、更准确地调整胰岛素输注，从而在预防严重高血糖和低血糖方面提供益处，因为血糖浓度的趋势更容易识别。越来越明显的是，单一的血糖目标/范围可能并不适合所有患者在所有时间，就像许多其他重症监护患者管理方面一样，个性化的血糖控制方法可能更为合适。在这里，我们考虑了一些支持不同血糖目标的证据，这些证据适用于不同的患者群体，重点关注有糖尿病和无糖尿病以及神经重症监护病房患者。我们还讨论了一些尽管有证据表明有益，但 CGM 设备仍未在 ICU 中广泛使用的原因，并提出了一些需要研究的领域，以帮助将 CGM 从研究领域转移到常规临床使用。
