Nutrition support, carbohydrate feeding and insulin sensitivity in the critically ill patient: a complex relationship

被引:0
|
作者
Doola, Ra'eesa [1 ,2 ,3 ,6 ]
Dupuis, Claire [4 ]
Preiser, Jean-Charles [5 ]
机构
[1] Metro South Hlth, Ctr Functioning & Hlth Res, Brisbane, Qld, Australia
[2] Princess Alexandra Hosp, Metro South Hlth, Nutr & Dietet, Brisbane, Qld, Australia
[3] Univ Queensland, Fac Med, PA Southside Clin Sch, Brisbane, Qld, Australia
[4] CHU Clermont Ferrand, Serv Reanimat, Clermont Ferrand, France
[5] Univ Libre Bruxelles, HUB Hop Erasme, Serv Med Interne, Brussels, Belgium
[6] Princess Alexandra Hosp, Dept Nutr & Dietet, Bldg 15,199 Ipswich Rd, Brisbane, Qld 4102, Australia
关键词
carbohydrate; critically ill; glucose; glycaemic control; insulin; GLUCOSE CONTROL; BLOOD-GLUCOSE; THERAPY;
D O I
10.1097/MCO.0000000000001039
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Purpose of reviewThis review aims to summarize recent studies that highlight the complex relationship between nutrition, carbohydrate, insulin provision and glycaemic control in the critically ill patient population.Recent findingsResults of observational studies concur to support early hypoglycaemia and persisting hyperglycaemia as life-threatening events. In contrast, interventional studies indicate that early macronutrient restriction appears to reduce the benefits related to insulin therapy. This restriction is however associated with improved outcomes in itself. The potential role of modified enteral solutions as an adjunctive treatment to attenuate hyperglycaemia warrants further research. The selection of a therapeutic modality may also differ according to the characteristics of the setting, such as the nurse-to-patient ratio, the type and accuracy of meters, including near-continuous glucose monitoring and the availability of computer-guided protocols.SummaryThere appears to be significant interplay between nutrition, including carbohydrate provision, blood glucose control and clinical outcomes. Individualized care is probably needed to define the optimal glucose target and nutritional intervention. This can differ according to the preexistence of chronic hyperglycaemia, the timing from the onset of critical illness and the clinical condition itself.
引用
收藏
页码:350 / 354
页数:5
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