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Copyright ©The Author(s) 2021.
World J Diabetes. Oct 15, 2021; 12(10): 1719-1730
Published online Oct 15, 2021. doi: 10.4239/wjd.v12.i10.1719
Table 2 Glycemic targets in intensive care unit by casemix and thresholds
Casemix
Blood sample
Method
Glycemic target
Evidence
BurnsNot statedNot statedGlucose > 7.8 mmol/LIncreased pneumonia, ventilator-associated pneumonia, and urinary tract infection; Obs[72]
CardiacNot statedNot statedGlucose 4.4-6.1 mmol/LDecreased 30-d mortality compared to glucose 5-7.8 mmol/L; Obs[73]
DMNot statedPortable glucometer, blood gas analyzerGlucose < 14 mmol/LDecreased glycemic variability and incident hypoglycemia; before-and-after study[35]
DMArterial, venousBlood gas analyzerGlucose 10-14 mmol/LDecreased incident hypoglycemia; before-and-after study[74]. No increased risk of hospital-acquired infectious, cardiovascular, renal or neurological complications; before-and-after study[75]
DMNot statedPortable glucometerGlucose 5.6-7.8 mmol/LDecreased complications (infection, cardiac events, respiratory failure, kidney failure) after coronary artery bypass graft surgery compared to glucose 7.8-10 mmol/L; RCT[34]
DMNot statedPortable glucometerGlucose 5-7.8 mmol/LDecreased 30-day mortality compared to glucose 4.4-6.1 mmol/L; Obs[76]
MedicalCapillaryPortable glucometerGlucose > 7 mmol/LIncreased ICU mortality; Obs[77]
Medical-surgicalArterialPoint-of-care or blood gas or laboratory analyzersGlucose 8-10 mmol/LDecreased 90-d mortality and incident severe hypoglycemia compared to glucose 4.5-6.0 mmol/L; RCT[31]
Medical-surgicalNot statedPortable glucometerGlucose 4.4-6.1 mmol/LDecreased 30-d mortality compared to glucose 5-7.8 mmol/L in patients without DM; Obs[76]
Medical-surgicalArterialPoint-of-care or blood gas or laboratory analyzersGlucose 4.4-6.1 mmol/LIncreased incident severe hypoglycemia compared to more liberal control (95%CI of glucose -7.8-9.4) mmol/L; RCT[78]
Medical-surgicalArterial, capillaryGlucometerGlucose 10-11.1 mmol/LDecreased incident severe hypoglycemia compared to glucose 4.4-6.1 mmol/L; RCT[46]
Medical-surgicalArterial, capillary, venousGlucometer or blood gas analyzerGlucose 7.8-10 mmol/LDecreased incident severe hypoglycemia compared to glucose 4.4-6.1 mmol/L; RCT[79]
Medical-surgicalArterialPortable glucometerGlucose 7-9 mmol/LDecreased ICU mortality compared to out-of-range glucose; Obs[80]
Medical-surgicalArterial, capillaryGlucometer or blood gas analyzerGlucose < 10 mmol/LDecreased incident severe hypoglycemia compared to glucose 4.4-6.1 mmol/L; RCT[31,81]
Medical-surgicalArterialGlucometerGlucose < 8 mmol/LDecreased ICU mortality compared to higher glucose levels; Obs[82]
Medical-surgicalArterialBlood gas analyzerGlucose > 8.3 mmol/LIncreased ICU mortality compared to glucose 6.1-8.3; Obs[83]
Medical-surgicalArterial, capillaryGlucometerGlucose < 8.2 mmol/LDecreased ICU mortality compared to higher glucose levels; Obs[84]
Medical-surgicalArterial, venousGlucometerGlucose 4.4-7.8 mmol/LDecreased ICU and hospital mortality compared to glucose 7.8-10 mmol/L in patients without DM; Obs[26]
Medical-surgicalNot statedGlucometerGlucose 3.9-7.8 mmol/LTime in range associated with decreased ICU mortality in patients without DM; Obs[85]; Time in range associated with decreased ICU mortality in patients receiving insulin; Obs[86]
Medical-surgicalVenousLaboratoryLow SHR < 1Decreased hospital mortality compared to SHR > 1 regardless of baseline HbA1c; Obs[87]
Post-CACapillary, venousNot statedGlucose 3.9-7.8 mmol/LHigher survival, compared to higher glucose levels; Obs[88]
Post-CANot statedNot statedGlucose 4-10 mmol/LBetter neurological recovery, compared to higher glucose levels; Obs[33]
SurgicalArterialBlood gas analyzerGlucose 4.4-6.1 mmol/LDecreased hospital mortality, blood stream infections, acute renal failure, blood transfusion, critical-illness polyneuropathy, prolonged mechanical ventilation, compared to glucose 10-11.1 mmol/L; RCT[42]
SurgicalNot statedNot statedGlucose 4.4-6.1 mmol/LDecreased post-operative renal failure and 30-d mortality compared to glucose > 8.3 mmol/L; Obs[89]
SurgicalArterial, capillary, venousGlucometer or blood gas analyzerGlucose 4.4-7.8 mmol/LDecreased hospital mortality compared to glucose >7.8 mmol/L; Obs[27]
SurgicalNot statedGlucometerGlucose 4-8 mmol/LDecreased surgical site infection after coronary artery bypass graft surgery compared to glucose 4-10 mmol/L; before-and-after study[28]
SurgicalArterial, venousContinuous sensor, in a closed-loop systemGlucose 4.4-6.1 mmol/LDecreased surgical site infection post- hepato-biliary-pancreatic surgery, compared to glucose 7.7-10.0 mmol/L; RCT[90]
SurgicalArterialBlood gas analyzerGlucose 6.7-8.9 mmol/LDecreased mortality compared to glucose 8.9-10 mmol/L; quasi-experimental (alternate allocation of participants)[91]
SurgicalCapillaryGlucometerGlucose 6.1-8.3 mmol/LDecreased surgical site infection and atrial fibrillation after coronary artery bypass graft surgery; before-and-after study[29]
TBIArterialBlood gas analyzerGlucose 3.5-6.5 mmol/LReduced intracranial hypertension and decreased rate of pneumonia, bacteremia and urinary tract infections during 2nd week, compared to glucose 5-8 mmol/L; Obs[5]
TBINot statedNot statedGlucose 4.4-6.7 mmol/LDecreased risk of poor neurological outcomes but increased risk of hypoglycemia, and no mortality benefit, compared to higher glucose targets; systematic review of RCT[30]
TBIArterialPoint-of-care or blood gas or laboratory analyzersGlucose 8-10 mmol/LDecreased incident severe hypoglycemia, but no mortality benefit, compared to glucose 4.5-6.0 mmol/L; RCT[92]
TBINot statedNot statedGlucose < 11.1 mmol/LDecreased hospital mortality compared to glucose > 11.1 mmol/L; Obs[93]
TraumaArterial, capillary, venousPoint-of-care or laboratory analyzersGlucose < 7.8 mmol/LDecreased ICU mortality compared to glucose > 7.8 mmol/L; Obs[94]
TraumaCapillaryNot statedGlucose < 10 mmol/LDecreased hospital mortality compared to glucose > 10 mmol/L; Obs[32]