Best practice & research. Clinical anaesthesiology
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Best Pract Res Clin Anaesthesiol · Dec 2009
ReviewHow accurately do we measure blood glucose levels in intensive care unit (ICU) patients?
Hyperglycaemia is commonly found in critically ill patients as a result of numerous processes such as increased gluconeogenesis and glycogenolysis caused by elevated levels of corresponding hormones and insulin resistance. As the clinical consequence of hyperglycaemia has been shown to increase morbidity and mortality in various clinical settings, many hospitals by now use tight glycaemic control protocols for their patients in intensive care units to maintain normoglycaemia. ⋯ Therefore, in almost all cases, this will be done by point-of-care testing methods, raising the question of how accurately blood glucose levels are actually measured and what devices should be used. This review focusses on glucose assay principles, specimen matrices, influences and interferences of glucose measurements and finally looks at the numerous evaluation reports on point-of-care glucose testing devices.
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Tight glycaemic control (TGC) for patients treated in an intensive care unit ICU is associated with an increased risk for hypoglycaemia. Since hypoglycaemia mainly occurs in the sickest patients, no matter whether TGC is applied or not, it might be a marker for severity of illness or a harmful event in itself. Furthermore, it remains a matter of debate whether harmful effects of hypoglycaemia outbalance the clinical benefits of TGC. This review focusses on the clinical manifestations of hypoglycaemia in the critically ill and highlights its potential short- and long-term consequences specifically concerning neurocognitive function.
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Best Pract Res Clin Anaesthesiol · Dec 2009
ReviewModulating postoperative insulin resistance by preoperative carbohydrate loading.
The concept of preoperative overnight fasting was challenged and proved to have no benefits over allowing patients to drink clear fluids up until 2 h before surgery. This led to changes in the guidelines for preoperative fasting in many countries around the world. This concept has more recently been developed further. ⋯ This article summarises the present understanding of the mechanisms behind the positive clinical effects and gives an overview of the information available regarding the clinical effects of this treatment. Finally, the article summarises the most recently published national guidelines on preoperative fasting routines where preoperative carbohydrates are recommended for use before a major surgery. These are to be considered for all patients allowed to drink clear fluids and undergoing elective surgery.
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Best Pract Res Clin Anaesthesiol · Dec 2009
ReviewHow to weigh the current evidence for clinical practice.
This article presents a template for judging trials of tight glucose control in critically ill patients. It reviews threats to both internal validity and generalisability using examples from the current literature. ⋯ These may relate to the setting, the patients or the practical delivery of tight glucose control or other interventions. Once identified, a judgement must be made for each difference of whether it is likely to modify the effect of tight glucose control.