General Critical Care

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Mazen Kherallah

March 17, 2024

Society of Critical Care Medicine Guidelines on Glycemic Control for Critically Ill Children and Adults 2024

Based on available randomized controlled trial data, in critically ill adults, we “suggest against” titrating an insulin infusion to a lower BG target INT: 4.4–7.7 mmol/L (80–139 mg/dL) as compared with a higher BG target range, CONV: 7.8–11.1 mmol/L (140–200 mg/dL) to reduce the risk of hypoglycemia (Conditional recommendation; moderate certainty of evidence). Observational data suggest a potential benefit of personalized glucose targets that more closely match chronic prehospital glycemic control. We recommend high-quality interventional trials of individualized glycemic targets in critically ill adults, stratified by prior glycemic control (such as indicated by glycosylated hemoglobin) (research statement).

2012 Statement

In adult critically ill patients, we suggest that a BG ≥ 150 mg/dL should trigger initiation of insulin therapy, titrated to keep BG < 150 mg/dL for most adult ICU patients and to maintain BG values absolutely <180 mg/dL using a…

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…