• Carole Ichai, Jean-Charles Preiser, Société Française d'Anesthésie-Réanimation, Société de Réanimation de langue Française, and Experts group.
• Medical and Surgical Intensive Care Unit, Saint-Roch Hospital, University of Medicine of Nice, 06000 Nice, France. ichai@unice.fr
• Crit Care. 2010 Jan 1;14(5):R166.

IntroductionThe purpose of this research is to provide recommendations for the management of glycemic control in critically ill patients.MethodsTwenty-one experts issued recommendations related to one of the five pre-defined categories (glucose target, hypoglycemia, carbohydrate intake, monitoring of glycemia, algorithms and protocols), that were scored on a scale to obtain a strong or weak agreement. The GRADE (Grade of Recommendation, Assessment, Development and Evaluation) system was used, with a strong recommendation indicating a clear advantage for an intervention and a weak recommendation indicating that the balance between desirable and undesirable effects of an intervention is not clearly defined.ResultsA glucose target of less than 10 mmol/L is strongly suggested, using intravenous insulin following a standard protocol, when spontaneous food intake is not possible. Definition of the severe hypoglycemia threshold of 2.2 mmol/L is recommended, regardless of the clinical signs. A general, unique amount of glucose (enteral/parenteral) to administer for any patient cannot be suggested. Glucose measurements should be performed on arterial rather than venous or capillary samples, using central lab or blood gas analysers rather than point-of-care glucose readers.ConclusionsThirty recommendations were obtained with a strong (21) and a weak (9) agreement. Among them, only 15 were graded with a high level of quality of evidence, underlying the necessity to continue clinical studies in order to improve the risk-to-benefit ratio of glucose control.

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