viernes, 14 de julio de 2017

Diabetes en el paciente grave / Diabetes in the critically ill patient

Julio 11, 2017. No. 2746

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Estos días se ha enviado información sobre endocrinopatías diversas. Si duda la diabetes es la patología endocrina más frecuente por lo que se harán varios envíos con este tema apasionante. Después seguiremos con tiroides, alteraciones pituitarias y otras endocrinopatías de interés capital en la medicina perioperatoria, medicina crítica y del dolor. Disfrute su lectura

Information on endocrinopathies has been sent to you in these days. Diabetes in the most common endocrine pathology, so we will make several submissions with this exciting topic. Later we will continue with thyroid, pituitary alterations and other endocrinopathies of capital interest in perioperative medicine, critical medicine and pain.
Enjoy your reading

Manejo del diabético grave
Management of critically ill patients with diabetes.
World J Diabetes. 2017 Mar 15;8(3):89-96. doi: 10.4239/wjd.v8.i3.89.
Disorders of glucose homeostasis, such as stress-induced hypoglycemia and hyperglycemia, are common complications in patients in the intensive care unit. Patients with preexisting diabetes mellitus (DM) are more susceptible to hyperglycemia, as well as a higher risk from glucose overcorrection, that may results in severe hypoglycemia. In critically ill patients with DM, it is recommended to maintain a blood glucose range between 140-180 mg/dL. In neurological patients and surgical patients, tighter glycemic control (i.e., 110-140 mg/d) is recommended if hypoglycemia can be properly avoided. There is limited evidence that shows that critically ill diabetic patients with a glycosylated hemoglobin levels above 7% may benefit from looser glycemic control, in order to reduce the risk of hypoglycemia and significant glycemic variability.
KEYWORDS: Critical care; Diabetes mellitus; Glycemic control; Hypoglycemia; Intensive care unit; Stress hyperglycemia

Manejo del paciente grave con diabetes tipo 2. La necesidad de terapia personalizada
Management of critically ill patients with type 2 diabetes: The need for personalised therapy.
World J Diabetes. 2015 Jun 10;6(5):693-706. doi: 10.4239/wjd.v6.i5.693.
Critical illness in patients with pre-existing diabetes frequently causes deterioration in glycaemic control. Despite the prevalence of diabetes in patients admitted to hospital and intensive care units, the ideal management of hyperglycaemia in these groups is uncertain. There are data that suggest that acute hyperglycaemia in critically ill patients without diabetes is associated with increased mortality and morbidity. Exogenous insulin to keep blood glucose concentrations < 10 mmol/L is accepted as standard of care in this group. However, preliminary data have recently been reported that suggest that chronic hyperglycaemia may result in conditioning, which protects these patients against damage mediated by acute hyperglycaemia. Furthermore, acute glucose-lowering to < 10 mmol/L in patients with diabetes with inadequate glycaemic control prior to their critical illness appears to have the capacity to cause harm. This review focuses on glycaemic control in critically ill patients with type 2 diabetes, the potential for harm from glucose-lowering and the rationale for personalised therapy.
KEYWORDS: Critically ill; Diabetes; Intensive care; Management; Personalised therapy

Control de la glucosa en la UCI: Una historia continua.
Glucose Control in the ICU: A Continuing Story.
J Diabetes Sci Technol. 2016 Nov 1;10(6):1372-1381. Print 2016 Nov.
In the present era of near-continuous glucose monitoring (CGM) and automated therapeutic closed-loop systems, measures of accuracy and of quality of glucose control need to be standardized for licensing authorities and to enable comparisons across studies and devices. Adequately powered, good quality, randomized, controlled studies are needed to assess the impact of different CGM devices on the quality of glucose control, workload, and costs. The additional effects of continuing glucose control on the general floor after the ICU stay also need to be investigated. Current algorithms need to be adapted and validated for CGM, including effects on glucose variability and workload. Improved collaboration within the industry needs to be encouraged because no single company produces all the necessary components for an automated closed-loop system. Combining glucose measurement with measurement of other variables in 1 sensor may help make this approach more financially viable.
KEYWORDS: continuous glucose control; diabetes; intensive care; time in band
Año de revisión 2013: Cuidados Críticos - metabolismo.
Year in review 2013: Critical Care--metabolism.
Crit Care. 2014 Oct 27;18(5):571. doi: 10.1186/s13054-014-0571-4.
Novel insights into the metabolic alterations of critical illness, including new findings on association between blood glucose at admission and poor outcome, were published in Critical Care in 2013. The role of diabetic status in the relation of the three domains of glycemic control (hyperglycemia, hypoglycemia, and glycemic variability) was clarified: the association between mean glucose, high glucose variability, and ICU mortality was stronger in the non-diabetic than in diabetic patients. Improvements in the understanding of pathophysiological mechanisms of stress hyperglycemia were presented. Novel developments for the management of glucose control included automated closed-loop algorithms based on subcutaneous glucose measurements and microdialysis techniques. In the field of obesity, some new hypotheses that could explain the 'obesity paradox' were released, and a role of adipose tissue in the response to stress was suggested by the time course of adipocyte fatty-acid binding protein concentrations. In the field of nutrition, beneficial immunological effects have been associated with early enteral nutrition. Early enteral nutrition was significantly associated with potential beneficial effects on the phenotype of lymphocytes. Uncertainties regarding the potential benefits of small intestine feeding compared with gastric feeding were further investigated. No significant differences were observed between the nasogastric and nasojejunal feeding groups in the incidence of mortality, tracheal aspiration, or exacerbation of pain. The major risk factors to develop diarrhea in the ICU were described. Finally, the understanding of disorders associated with trauma and potential benefits of blood acidification was improved by new experimental findings.

XIV Congreso Virtual Mexicano de Anestesiología 2017
Octubre 1-Diciembre 31, 2017
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