Understanding the causes of hyperglycemia in burn patients

Abstract

DOI of original article: 10.1016/j.jss.2012.0 * Corresponding author. Department of Surge Center, 10 Union Square East, Suite 2M, New E-mail address: mleitman@chpnet.org (I. 0022-4804/$ e see front matter a 2013 Elsev doi:10.1016/j.jss.2012.03.042 Hyperglycemia is commonly encountered in the critically ill patient. Although this is believed to be an adaptive stress response, hyperglycemia is in fact correlated with adverse outcomes [1]. Accordingly, critically ill patients are believed to benefit from enhanced glucose control. Several randomized controlled trials (RCTs) of strict glucose control with insulin therapy have been performed, most notably the 2001 landmark study by Van den Berghe et al., which found that intensive insulin therapy to maintain glucose at 80e110 mg/dL significantly reduced morbidity and mortality in intensive care unit (ICU) patients [2]. However, subsequent RCTs have reported conflicting results [1]. A metaanalysis of RCTs concluded that only surgical ICU patients, not medical ICU patients, enjoyed the benefit of strict glycemic control [3]. The large multicenter NICESUGAR trial demonstrated that an intermediate glucose target (140e180 mg/dL) was ideal, and resulted in lower mortality than stricter control (80e110 mg/dL) [4]. At the present time, due to conflicting data, the optimal target glucose level remains unclear. These data have been extrapolated to burn patients, despite the fact that burn patients were underrepresented in the RCTs of glycemic control in the ICU. Hyperglycemia was