General Critical Care

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…

Pharmacotherapy for Reducing RBC Transfusion for Patients in... : Critical Care Medicine (lww.com)

This systematic review and network meta-analysis in Critical Care Medicine (April 2024) assessed therapies to reduce RBC transfusion needs in ICU patients. Searching MEDLINE, CENTRAL, and Embase until July 2023, it included 75 studies with 15,091 patients. Combination therapy of erythropoiesis-stimulating agents (Epo) and iron was found to notably decrease transfusion requirements (RR: 0.60; moderate confidence), outperforming Epo or iron monotherapy (RR: 0.81 and 0.83; low confidence, respectively). No significant increase in venous thromboembolism or infection risks was associated with combination therapy. In contrast, Epo alone might increase infection risks. The efficacy of vitamin D3 and HIF-PHI remains unclear.

In a systematic review of 15 randomized clinical trials comparing the efficacy and safety of early active mobilization with usual care in critically ill adults. The primary outcome was days alive and out of hospital within 180 days, with a result of an increase of 4.28 days in the active mobilization group. The intervention also improved physical function in survivors at 6 months with a 95.1% probability. However, there is a possibility of increased adverse events and 6-month mortality with early active mobilization.

https://evidence.nejm.org/doi/full/10.1056/EVIDoa2200234