The guidelines for nutritional support in critically ill adult patients differ in various aspects. The optimal amount of energy and nutritional substrates supplied is important for reducing morbidity and mortality, but unfortunately this is not well known, because the topic is complex and every patient is individual. The aim of this review was to gather recent pertinent information concerning the nutritional support of critically ill patients in the intensive care unit (ICU) with respect to the energy, protein, carbohydrate, and lipid intakes and the effect of their specific utilization on morbidity and mortality. Enteral nutrition (EN) is generally recommended over parenteral nutrition (PN) and is beneficial when administered within 24-48 h after ICU admission. In contrast, early PN does not provide substantial advantages in terms of morbidity and mortality, and the time when it is safe and beneficial remains unclear. The most advantageous recommendation seems to be administration of a hypocaloric (<20 kcal · kg-1 · d-1), high-protein diet (amino acids at doses of ≥2 g · kg-1 · d-1), at least during the first week of critical illness. Another important factor for reducing morbidity is the maintenance of blood glucose concentrations at 120-150 mg/dL, which is accomplished with the use of insulin and lower doses of glucose of 1-2 g · kg-1 · d-1, because this prevents the risk of hypoglycemia and is associated with a better prognosis according to recent studies. A fat emulsion is used as a source of required calories because of insulin resistance in the majority of patients. In addition, lipid oxidation in these patients is ∼25% higher than in healthy subjects.

• Klíčová slova
• energy expenditure, energy metabolism, enteral nutrition, glucose control, indirect calorimetry, metabolism, parenteral nutrition, timing for nutrition commencement,
• MeSH
• dietní proteiny aplikace a dávkování   MeSH
• dietní sacharidy aplikace a dávkování   MeSH
• dietní tuky aplikace a dávkování   MeSH
• dospělí MeSH
• energetický metabolismus MeSH
• energetický příjem * MeSH
• enterální výživa MeSH
• inzulin krev   MeSH
• jednotky intenzivní péče MeSH
• krevní glukóza metabolismus   MeSH
• kritický stav epidemiologie   terapie   MeSH
• lidé MeSH
• metaanalýza jako téma MeSH
• morbidita MeSH
• mortalita MeSH
• nutriční nároky MeSH
• parenterální výživa MeSH
• pozorovací studie jako téma MeSH
• randomizované kontrolované studie jako téma MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• systematický přehled MeSH
• Názvy látek
• dietní proteiny MeSH
• dietní sacharidy MeSH
• dietní tuky MeSH
• inzulin MeSH
• krevní glukóza MeSH

BACKGROUND: The surgical resection of lung disrupts glucose homeostasis and causes hyperglycemia, as in any other major surgery or critical illness. We performed a prospective study where we carefully lowered hyperglycemia by insulin administration during the surgery, and for the first time we monitored immediate insulin effects on lung physiology and gene transcription. METHODS: The levels of blood gases (pH, pCO2, pO2, HCO3-, HCO3- std, base excess, FiO2, and pO2/FiO2) were measured at the beginning of surgery, at the end of surgery, and two hours after. Samples of healthy lung tissue surrounding the tumour were obtained during the surgery, anonymized and sent for subsequent blinded qPCR analysis (mRNA levels of surfactant proteins A1, A2, B, C and D were measured). This study was done on a cohort of 64 patients who underwent lung resection. Patients were randomly divided, and half of them received insulin treatment during the surgery. RESULTS: We demonstrated for the first time that insulin administered intravenously during lung resection does not affect levels of blood gases. Furthermore, it does not induce immediate changes in the expression of surfactant proteins. CONCLUSION: According to our observations, short insulin treatment applied intravenously during resection does not affect the quality of breathing.

• MeSH
• analýza krevních plynů MeSH
• časové faktory MeSH
• dospělí MeSH
• exprese genu účinky léků   MeSH
• hydrogenuhličitany krev   MeSH
• hyperglykemie farmakoterapie   etiologie   MeSH
• hypoglykemika aplikace a dávkování   MeSH
• intravenózní podání MeSH
• inzulin aplikace a dávkování   MeSH
• koncentrace vodíkových iontů MeSH
• krevní glukóza účinky léků   MeSH
• kyslík krev   MeSH
• lidé středního věku MeSH
• lidé MeSH
• messenger RNA metabolismus   MeSH
• nádory plic chirurgie   MeSH
• oxid uhličitý krev   MeSH
• plíce účinky léků   patofyziologie   MeSH
• pneumektomie škodlivé účinky   MeSH
• poruchy acidobazické rovnováhy MeSH
• prospektivní studie MeSH
• proteiny asociované s plicním surfaktantem genetika   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH
• Názvy látek
• hydrogenuhličitany MeSH
• hypoglykemika MeSH
• inzulin MeSH
• krevní glukóza MeSH
• kyslík MeSH
• messenger RNA MeSH
• oxid uhličitý MeSH
• proteiny asociované s plicním surfaktantem MeSH

During the last 2 decades, the treatment of hyperglycemia in critically ill patients has become one of the most discussed topics in the intensive medicine field. The initial data suggesting significant benefit of normalization of blood glucose levels in critically ill patients using intensive intravenous insulin therapy have been challenged or even neglected by some later studies. At the moment, the need for glucose control in critically ill patients is generally accepted yet the target glucose values are still the subject of ongoing debates. In this review, we summarize the current data on the benefits and risks of tight glucose control in critically ill patients focusing on the novel technological approaches including continuous glucose monitoring and its combination with computer-based algorithms that might help to overcome some of the hurdles of tight glucose control. Since increased risk of hypoglycemia appears to be the major obstacle of tight glucose control, we try to put forward novel approaches that may help to achieve optimal glucose control with low risk of hypoglycemia. If such approaches can be implemented in real-world practice the entire concept of tight glucose control may need to be revisited.

• Klíčová slova
• continuous glucose monitoring, critically ill patients, glucose control, hypoglycemia, intensive care unit,
• MeSH
• algoritmy MeSH
• hypoglykemika terapeutické užití   MeSH
• inzulin terapeutické užití   MeSH
• jednotky intenzivní péče MeSH
• krevní glukóza * MeSH
• kritický stav MeSH
• lidé MeSH
• péče o pacienty v kritickém stavu metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH
• Názvy látek
• hypoglykemika MeSH
• inzulin MeSH
• krevní glukóza * MeSH

AIM: In postcardiac surgery patients, we assessed the performance of a system for intensive intravenous insulin therapy using continuous glucose monitoring (CGM) and enhanced model predictive control (eMPC) algorithm. METHODS: Glucose control in eMPC-CGM group (n = 12) was compared with a control (C) group (n = 12) treated by intravenous insulin infusion adjusted according to eMPC protocol with a variable sampling interval alone. In the eMPC-CGM group glucose measured with a REAL-Time CGM system (Guardian RT) served as input for the eMPC adjusting insulin infusion every 15 minutes. The accuracy of CGM was evaluated hourly using reference arterial glucose and Clarke error-grid analysis (C-EGA). Target glucose range was 4.4-6.1 mmol/L. RESULTS: Of the 277 paired CGM-reference glycemic values, 270 (97.5%) were in clinically acceptable zones of C-EGA and only 7 (2.5%) were in unacceptable D zone. Glucose control in eMPC-CGM group was comparable to C group in all measured values (average glycemia, percentage of time above, within, and below target range,). No episode of hypoglycemia (<2.9 mmol) occurred in eMPC-CGM group compared to 2 in C group. CONCLUSION: Our data show that the combination of eMPC algorithm with CGM is reliable and accurate enough to test this approach in a larger study population.

• MeSH
• algoritmy MeSH
• diabetes mellitus 1. typu krev   chirurgie   MeSH
• intravenózní infuze MeSH
• inzulin aplikace a dávkování   MeSH
• jednotky intenzivní péče MeSH
• krevní glukóza analýza   MeSH
• lidé středního věku MeSH
• lidé MeSH
• pooperační období MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• inzulin MeSH
• krevní glukóza MeSH