Stress Hyperglycemia and Osteocalcin in COVID-19 Critically Ill Patients on Artificial Nutrition

We aimed to study the possible association of stress hyperglycemia in COVID-19 critically ill patients with prognosis, artificial nutrition, circulating osteocalcin, and other serum markers of inflammation and compare them with non-COVID-19 patients. Fifty-two critical patients at the intensive care unit (ICU), 26 with COVID-19 and 26 non-COVID-19, were included. Glycemic control, delivery of artificial nutrition, serum osteocalcin, total and ICU stays, and mortality were recorded. Patients with COVID-19 had higher ICU stays, were on artificial nutrition for longer (p = 0.004), and needed more frequently insulin infusion therapy (p = 0.022) to control stress hyperglycemia. The need for insulin infusion therapy was associated with higher energy (p = 0.001) and glucose delivered through artificial nutrition (p = 0.040). Those patients with stress hyperglycemia showed higher ICU stays (23 ± 17 vs. 11 ± 13 days, p = 0.007). Serum osteocalcin was a good marker for hyperglycemia, as it inversely correlated with glycemia at admission in the ICU (r = −0.476, p = 0.001) and at days 2 (r = −0.409, p = 0.007) and 3 (r = −0.351, p = 0.049). In conclusion, hyperglycemia in critically ill COVID-19 patients was associated with longer ICU stays. Low circulating osteocalcin was a good marker for stress hyperglycemia.

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Insulin Infusion Therapy in Critically Ill Patients

Canadian Journal of Diabetes ◽

10.1016/j.jcjd.2014.01.016 ◽

2014 ◽

Vol 38 (2) ◽

pp. 144-150 ◽

Cited By ~ 8

Author(s):

Jean-Marie Boutin ◽

Lyne Gauthier

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Insulin Infusion ◽

Infusion Therapy

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Reply: “Procedural Considerations on the Use of Polyurethane and/or Conical Cuffs”; “Estimating the Risk of Ventilator-associated Pneumonia as a Function of Time”; “Is Tracheobronchial Colonization a Good Marker for Microaspiration in Intubated Critically Ill Patients?”; and “TranslatingIn VitroResearch: Improving Endotracheal Tube Bench Test Methodology”

American Journal of Respiratory and Critical Care Medicine ◽

10.1164/rccm.201505-0895le ◽

2015 ◽

Vol 192 (5) ◽

pp. 642-644

Author(s):

François Philippart ◽

Laurent Quinquis ◽

Stéphane Gaudry ◽

Islem Ouanes ◽

Xavier Forceville ◽

...

Keyword(s):

Endotracheal Tube ◽

Critically Ill ◽

Critically Ill Patients ◽

Bench Test ◽

Ventilator Associated Pneumonia ◽

Good Marker ◽

Test Methodology

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Guideline-Concordant Insulin Infusion Initiation Among Critically Ill Patients With Sepsis

Endocrine Practice ◽

10.1016/j.eprac.2021.01.018 ◽

2021 ◽

Author(s):

Nicholas A. Bosch ◽

Kathryn L. Fantasia ◽

Katherine L. Modzelewski ◽

Sara M. Alexanian ◽

Allan J. Walkey

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Insulin Infusion

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Parenteral nutrition in the ICU

10.1093/med/9780199600830.003.0207 ◽

2016 ◽

Author(s):

Jonathan Cohen ◽

Shaul Lev

Keyword(s):

Animal Models ◽

Enteral Nutrition ◽

Parenteral Nutrition ◽

Critically Ill ◽

Critically Ill Patients ◽

Nutrition Support ◽

Glutamine Supplementation ◽

Artificial Nutrition ◽

Omega 3 ◽

Aspen Guidelines

Parenteral nutrition (PN) is a technique of artificial nutrition support, which consists of the intravenous administration of macronutrients, micronutrients, and water. PN has become integrated into intensive care unit (ICU) patient management with the aim of preventing energy deficits and preserving lean body mass. The addition of PN to enteral nutrition is known as supplemental PN. Parenteral feeding should be considered whenever enteral nutritional support is contraindicated, or when enteral nutrition alone is unable to meet energy and nutrient requirements. International guidelines differ considerably regarding the indications for PN. Thus, the ESPEN guidelines recommend initiating PN in critically-ill patients who do not meet caloric goals within 2–3 days of commencing EN, while the Canadian guidelines recommend PN only after extensive attempts to feed with EN have failed. The ASPEN guidelines advocate administering PN after 8 days of attempting EN unsuccessfully. Several studies have demonstrated that parenteral glutamine supplementation may improve outcome, and the ESPEN guidelines give a grade A recommendation to the use of glutamine in critically-ill patients who receive PN. Studies on IV omega-3 fatty acids have yielded promising results in animal models of acute respiratory distress syndrome and proved superior to solutions with omega -6 compositions. The discrepancy between animal models and clinical practice could be related to different time frames.

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Pharmacokinetic Optimisation of Aminophylline Infusions in Critically Ill Patients

Anaesthesia and Intensive Care ◽

10.1177/0310057x8301100307 ◽

1983 ◽

Vol 11 (3) ◽

pp. 220-227 ◽

Cited By ~ 1

Author(s):

K. F. Ilett ◽

R. L. Nation ◽

B. Silbert ◽

T. E. Oh

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Venous Blood ◽

Plasma Concentrations ◽

Sampling Time ◽

Infusion Therapy ◽

Plasma Theophylline ◽

Total Body ◽

Theophylline Kinetics ◽

Body Clearance

The method of Chiou et al.4 was used to predict theophylline kinetics in eleven critically ill patients with either acute severe asthma or bronchoconstriction. Following the commencement of an accurately metered infusion of aminophylline, venous blood samples were taken at approximately 1, 5 hours and 7-12 hours for measurement of plasma theophylline concentration. The 1- and 5-hour levels were used to estimate total body clearance and plasma concentration of theophylline at the 7-12-hour sampling time. Using these values, the infusion rate was adjusted if necessary and the protocol repeated. Initial predictions were unreliable in two patients because of continued absorption of theophylline from pre-infusion therapy with aminophylline suppositories or slow-release theophylline tablets. In the remaining studies there was a significant correlation (y = 0.9x + 0.55, r2 = 0.93, p < 0.01, n = 19) between predicted and actual plasma concentrations at the 7-12-hour sampling time. In three patients, sequential estimates of theophylline clearance showed an approximate twofold variation and in another two patients, there was evidence of concentration-and/or time-dependent theophylline kinetics.

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Understanding safety differently: developing a model of resilience in the use of intravenous insulin infusions in hospital in-patients—a feasibility study protocol

BMJ Open ◽

10.1136/bmjopen-2019-029997 ◽

2019 ◽

Vol 9 (7) ◽

pp. e029997

Author(s):

Mais Hasan Iflaifel ◽

Rosemary Lim ◽

Kath Ryan ◽

Clare Crowley ◽

Rick Iedema

Keyword(s):

Blood Glucose ◽

Phase I ◽

Critically Ill ◽

Critically Ill Patients ◽

Insulin Infusion ◽

University Hospitals ◽

Glucose Levels ◽

Oxford University ◽

Intravenous Insulin ◽

Blood Glucose Levels

BackgroundIntravenous insulin infusions are considered the treatment of choice for critically ill patients and non-critically ill patients with persistent raised blood glucose who are unable to eat, to achieve optimal blood glucose levels. The benefits of using intravenous insulin infusions as well as the problems experienced are well described in the scientific literature. Traditional approaches for improving patient safety have focused on identifying errors, understanding their causes and designing solutions to prevent them. Such approaches do not take into account the complex nature of healthcare systems, which cannot be controlled solely by following standards. An emerging approach called Resilient Healthcare proposes that, to improve safety, it is necessary to focus on how work can be performed successfully as well as how work has failed.Methods and analysisThe study will be conducted at Oxford University Hospitals NHS Foundation Trust and will involve three phases. Phase I: explore how work is imagined by analysing intravenous insulin infusion guidelines and conducting focus group discussions with guidelines developers, managers and healthcare practitioners. Phase II: explore the interplay between how work is imagined and how work is performed using mixed methods. Quantitative data will include blood glucose levels, insulin infusion rates, number of hypoglycaemic and hyperglycaemic events from patients’ electronic records. Qualitative data will include video reflexive ethnography: video recording healthcare practitioners using intravenous insulin infusions and then conducting reflexive meetings with them to discuss selected video footage. Phase III: compare findings from phase I and phase II to develop a model for using intravenous insulin infusions.Ethics and disseminationEthical approvals have been granted by the South Central—Oxford C Research Ethics Committee, Oxford University Hospitals NHS Foundation Trust and University of Reading. The results will be disseminated through presentations at appropriate conferences and meetings, and publications in peer-reviewed journals.

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