Tight control of glycaemia in critically ill patients

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Abstract
This manuscript attempts to review the effects associated with hyperglycaemia in critically ill patients and the effects of various insulin regimens. The available clinical findings and pertinent experimental data are examined. Intensive insulin therapy titrated to maintain blood glucose level between 4.4 and 6.1 mmol/l during intensive care unit stay has recently been shown to significantly decrease mortality, septic morbidity, sepsis-related organ failure, transfusion requirements and polyneuropathies. Prior studies have already documented that hyperglycaemia on admission is related to susceptibility to infections and worse outcomes following myocardial and cerebral ischaemic events. Additional effects of insulin, unrelated to the control of glycaemia, have also been reported. Intensive insulin therapy is probably warranted in most categories of critically ill patients, although some of the underlying mechanisms of its beneficial effects still need to be elucidated.