Critical Care Scrutinizes Metabolic Support of the Very Ill
Controlling Blood Sugar Proves Critical in the ICU
DES PLAINES, Ill. – Critical care experts offered controversial and diverging opinions regarding metabolic support of patients with sepsis at an internationally prominent roundtable. The follow-up summary is being published in a special supplement to the September issue of Critical Care Medicine, the journal of the Society of Critical Care Medicine.
Joseph E. Parrillo, MD, the Editor-in-Chief of Critical Care Medicine, stated: “Critical Care Medicine is very pleased to publish this supplement on metabolic support in sepsis and multiple organ failure. The supplement provides a comprehensive discussion of major advances in our understanding of glucose control and other metabolic regulatory processes during sepsis and multiple organ failure in the critically ill. We believe that our journal and its supplements provide the ideal forum for the discussion of such cutting-edge issues in critical care.”
“The emerging arena of metabolic support in the ICU is rapidly gaining interest and support because it can improve patient outcomes,” explains roundtable co-chair Jan Wernerman, MD, PhD, professor of intensive care medicine at Karolinska University Hospital Huddinge, Karolinska Institute, Stockholm. Dr. Wernerman is co-editor of the Critical Care Medicine special supplement, Metabolic Support in Sepsis and Multiple Organ Failure: Proceedings of a Roundtable Conference in Brussels, Belgium, March 24-26, 2007.
The supplement contains the proceedings from the yearly international roundtable assembled by Jean-Louis Vincent, MD, PhD, FCCM. Each invited participant contributed a section to the supplement on his or her area of expertise in metabolic support in sepsis and multiple organ failure, with the intent to provide insight into the various areas in which metabolism can influence disease processes, patient management, and ultimately, outcomes.
“The roundtable in Brussels intentionally assembled experts with conflicting opinions. Discussions following the roundtable presentations were particularly useful because of the differences in opinion,” Dr. Wernerman comments.
The Critical Care Medicine supplement includes 31 articles exploring multifaceted opinions regarding metabolic support. Glucose control, glutamine, and antioxidants drew the most interest during the meeting. The supplement devotes several complementary chapters to each of these topics.
The growing body of knowledge concerning interactions between metabolism and endocrinology has highlighted the importance of metabolic support in the critically ill and injured. Research into compromised mitochondrial function, glucose control, insulin resistance, and glutamine and antioxidants has greatly influenced care in the intensive care unit (ICU).
“Research has shown that tight blood sugar control may improve outcomes for ICU patients with multiple organ failure, which carries the most negative ICU prognosis,” Dr. Wernerman continues. “Metabolic support including glutamine supplementation, selenium supplementation, and cortisol substitution, also has proven to be beneficial for multiple organ failure patients in pilot studies.
“The roundtable scrutinized evidence for the different types of metabolic support. All of the suggestions can be seen as controversial, since the existing evidence produces different interpretations,” explains Dr. Wernerman. “Tight glucose control is one such example. There is no consensus as to which patients should be controlled or when tight glucose control should be applied to critically ill patients. Increasing safety while avoiding the risk of hypoglycaemia when applying tight glucose control is also a matter of debate.”
The roundtable is considered a unique opportunity for advanced medicine. “It is one of the few opportunities within intensive care medicine for a forum discussion between leading experts. Other workshops are often company-driven, with inherent and obvious limitations,” comments Dr. Wernerman. The roundtable has been held for nearly a quarter of a century.
“Improved patient care is critical care’s next step. The present roundtable is an important test for the various interpretations of the data from which guidelines will eventually be written,” concludes Dr. Wernerman.
Critical Care Medicine is the official journal of the Society of Critical Care Medicine. It is the premier peer-reviewed, scientific publication in critical care medicine. Each issue presents critical care practitioners with clinical breakthroughs that lead to better patient care, the latest news on promising research, and advances in equipment and techniques.
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For more information, please contact Amanda Mannina at +1 847 827-7095 or amannina@sccm.org or Thomas Joseph at +1 847 827-7282 or tjoseph@sccm.org.
