Glycemic Control in Neurological Intensive Care Unit Patients

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Abstract

Critically ill patients often develop hyperglycemia because of the metabolic response to trauma and stress. In response to any form of damage to the organism, it reacts by increasing its own glucose production which subsequently causes hyperglycemia. This adaptive reaction of the organism is directed to aid in the rapid restoration after the damage. Therefore, glucose is an indispensable substrate in the critically ill which aids the reparation process. Severe and persistent hyperglycemia is associated with unfavorable outcomes and is considered to be an independent predictor of in-hospital mortality. The discussion remains on whether hyperglycemia is just a marker of increased stress which makes it a surrogate indicator of disease severity or if it is the reason for the unfavorable outcome. A few years ago, several published articles suggested that a «tight» glycemic control within the normal range improves treatment outcome. Over time, researchers have changed their point of view and currently there is a discussion on this matter in the scientific literatures. At the same time, the question of what glycemic level should be maintained for patients in the Neurological Intensive Care Unit is a matter of discussion. In this review, the authors analyzed the latest guidelines on treatment of critical patients with neurosurgical and neurological pathologies, specifically the glycemic control in this category of patients.

About the authors

Kirill Y. Krylov

The Russian National Research Medical University named aft er N.I. Pirogov; N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Healthcare of the Russian Federation

Author for correspondence.
Email: krkerk@gmail.com
ORCID iD: 0000-0002-1807-7546
SPIN-code: 9435-0854

MD, Cand. Sci. (Med.), Associate professor department anaesthesiology, reanimatology and intensive care medical Faculty RNRMU, Senior Researcher Intensive Care Unit N.N. Burdenko NMRCN, Senior Researcher Federal Research and Clinical Center of Intensive Care Medicine

Russian Federation, 1 Ostrovityanova st., Moscow, 117997; 4-th Tverskaya-Yamskaya st., 16, Moscow, 125047

Ivan A. Savin

N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Healthcare of the Russian Federation

Email: savin@nsi.ru
ORCID iD: 0000-0003-2594-5441
SPIN-code: 1342-7065

MD, Dr. Sci. (Med.), Professor

Russian Federation, 4-th Tverskaya-Yamskaya st., 16, Moscow, 125047

Sergey V. Sviridov

The Russian National Research Medical University named aft er N.I. Pirogov

Email: sergey.sviridov.59@mail.ru
ORCID iD: 0000-0002-9976-8903
SPIN-code: 4974-9195

MD, Dr. Sci. (Med.), Professor

Russian Federation, 1 Ostrovityanova st., Moscow, 117997

Irina V. Vedenina

The Russian National Research Medical University named aft er N.I. Pirogov

Email: viv54@mail.ru
ORCID iD: 0000-0002-1232-6767
SPIN-code: 6199-6980

MD, Cand. Sci. (Med.), Assistant Professor

Russian Federation, 1 Ostrovityanova st., Moscow, 117997

Marina V. Petrova

Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology; Peoples’ Friendship University of Russia (RUDN University)

Email: mail@petrovamv.ru
ORCID iD: 0000-0003-4272-0957
SPIN-code: 9132-4190

MD, PhD, Professor

Russian Federation, 25-2, Petrovka street, Moscow,107031; 6, Miklukho-Maklaya street, Moscow, 117198

Alexey N. Vorobyev

Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology

Email: avorobyev@fnkcrr.ru
ORCID iD: 0000-0003-3742-6171
SPIN-code: 3253-7996

MD, Neurosurgeon

Russian Federation, 25, building 2, Petrovka st., Moscow, 107031

Mohan Rubanes

Peoples’ Friendship University of Russia (RUDN University)

Email: drrubanesmohan@gmail.com
ORCID iD: 0000-0002-5661-2706
SPIN-code: 3342-9257

MD

Russian Federation, 6, Miklukho-Maklaya street, Moscow, 117198

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Copyright (c) 2020 Krylov K.Y., Savin I.A., Sviridov S.V., Vedenina I.V., Petrova M.V., Vorobyev A.N., Rubanes M.

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