General Critical Care

TGC-Fast Trial

In a study evaluating the impact of glucose control in ICU patients, participants were randomly divided into two groups: Liberal Glucose Control (initiating insulin only when blood-glucose exceeded 215 mg/dL) and Tight Glucose Control (targeting blood-glucose levels between 80 to 110 mg/dL using the LOGIC-Insulin algorithm). Both groups abstained from parenteral nutrition for one week.

Results showed that the median morning blood-glucose level was 140 mg/dL for the liberal group and 107 mg/dL for the tight control group. Severe hypoglycemia was slightly more prevalent in the tight-control group (1.0%) compared to the liberal group (0.7%). There was no significant difference in the duration of ICU care (P=0.94) or 90-day mortality rates (10.1% for liberal vs. 10.5% for tight; P=0.51) between the two groups.

Secondary outcomes revealed similar findings for both groups, although tight glucose control seemed to have a lower incidence of severe acute kidney injury and cholestatic…

Optimizing enteral nutrition delivery by implementing volume-based feeding protocol for critically ill patients: an updated meta-analysis and systematic review

Interruptions in EN therapy contribute to underfeeding in these patients. The volume-based feeding (VBF) protocol has gained attention as a solution to address under-delivery caused by interruptions.

This study provides an updated assessment of the efficacy of implementing the volume-based feeding (VBF) protocol for optimized enteral nutrition (EN) delivery in critically ill patients. Sixteen studies involving 2,896 critically ill patients were included in the meta-analysis. The VBF protocol significantly improved energy and protein delivery compared to the rate-based feeding (RBF) protocol. Patients in the VBF group had a shorter ICU stay. The VBF protocol did not increase the risk of death or prolong mechanical ventilation duration. Additionally, it did not have a significant impact on EN complications such as diarrhea, emesis, feeding intolerance, and gastric retention. The study concludes that the…