ICU Blood Glucose Management

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Questions and Answers

What was the result of a small trial with 20 patients that used a high-fat/low-carbohydrate enteral formulation in patients with respiratory failure?

Reduced duration of mechanical ventilation (correct)

Increased duration of mechanical ventilation

No effect on duration of mechanical ventilation

Increased CO2 production

When is the composite macronutrient ratio of fat to carbohydrate likely to have a clinically significant effect on lowering CO2 production?

In patients who are underfed

In patients who are being overfed (correct)

In patients with acute respiratory failure

In patients who are receiving standard nutrition support

What happens when total energy provision exceeds energy requirements in ICU patients?

CO2 production decreases

No effect on CO2 production

Energy requirements are met

CO2 production increases (correct)

Why should rapid infusion of IVFE be avoided in patients with severe pulmonary failure?

Because it can exacerbate CO2 retention Signup and view all the answers

What is the recommended energy density of fluid-restricted energy-dense EN formulations for patients with acute respiratory failure?

1.5–2 kcal/mL Signup and view all the answers

Why is it important to monitor serum phosphate concentrations when EN or PN is initiated in ICU patients with respiratory failure?

To prevent hypophosphatemia Signup and view all the answers

What is the main reason for considering fluid-restricted energy-dense EN formulations in patients with acute respiratory failure?

To prevent fluid accumulation, pulmonary edema, and renal failure Signup and view all the answers

What is the definition of moderate or severe hypophosphatemia?

Serum phosphorus concentrations ≤2.2 mg/dL Signup and view all the answers

What is the recommended target blood glucose range for the general ICU population?

140-180 mg/dL Signup and view all the answers

What is the potential outcome of hyperglycemia in acute illness and severe sepsis?

Poor outcomes Signup and view all the answers

What is the recommended range for tight glucose control (TGC) with intensive insulin therapy (IIT)?

80-110 mg/dL Signup and view all the answers

What is the recommended approach when transitioning from parenteral nutrition (PN) to enteral nutrition (EN)?

Decrease the amount of energy delivered by the parenteral route Signup and view all the answers

What is the recommended carbohydrate/fat ratio for the adult ICU patient with pulmonary failure?

No specific ratio is recommended Signup and view all the answers

What is the benefit of using enteral nutrition (EN) in critically ill patients?

Marked benefits Signup and view all the answers

What is the recommended threshold for discontinuing parenteral nutrition (PN)?

When EN exceeds 60% of target energy requirements Signup and view all the answers

What is the organization that recommends a target blood glucose range of 150-180 mg/dL for the general ICU population?

SCCM Signup and view all the answers

Study Notes

Blood Glucose Range

The recommended target blood glucose range for the general ICU population is 140-150 to 180 mg/dL.
Hyperglycemia is a common response to acute illness and severe sepsis, which may lead to poor outcomes.
The lower point of the range may vary for specific patient populations, such as post-cardiovascular surgery and head trauma patients.

Transition from PN to EN

Repeated efforts should be made to transition the patient from PN to enteral therapy once they are stabilized.
This is because of the marked benefits of EN, and to avoid complications associated with overfeeding.
The amount of energy delivered by PN should be reduced to compensate for the increase in energy being delivered enterally.
PN may be discontinued once EN exceeds 60% of target energy requirements and continues to be advanced towards goal.

Pulmonary Failure

The optimal carbohydrate/fat ratio for adult ICU patients with pulmonary failure is unclear.
High-fat/low-carbohydrate formulations should not be used in ICU patients with acute respiratory failure.
Macronutrient composition has a limited effect on CO2 production when energy requirements are met.
Total energy provision should not exceed energy requirements, as CO2 production increases with lipogenesis.
Rapid infusion of IVFE should be avoided in patients with severe pulmonary failure.

Energy-Dense EN Formulations

Fluid-restricted energy-dense EN formulations may be beneficial for adult ICU patients with acute respiratory failure, especially if they are in a state of volume overload.
These formulations can help restrict fluid administration and reduce fluid accumulation, pulmonary edema, and renal failure.

Serum Phosphate Monitoring

Serum phosphate concentrations should be monitored closely when EN or PN is initiated in ICU patients with respiratory failure.
Phosphate replacement should be done appropriately when needed, as hypophosphatemia is common in these patients.

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Description

Learn about the recommended blood glucose range for ICU patients, the effects of hyperglycemia, and transitioning from parenteral to enteral nutrition.