Glycemic control in the ICU

Glycemic control in the ICU. N Engl J Med 2010; 363:2540-2546

Kavanagh, BP and McCowen, KC.

http://www.nejm.org/doi/full/10.1056/NEJMcp1001115

A 42-year-old man is admitted to the intensive care unit (ICU) with an acute exacerbation of asthma associated with community-acquired pneumonia. He is treated with cefotaxime and azithromycin, nebulized albuterol, and intravenous hydrocortisone. He has no known history of diabetes mellitus. Shortly after admission, his arterial glucose concentration is 105 mg per deciliter (5.8 mmol per liter), and on the next day, it has increased to 195 mg per deciliter (10.8 mmol per liter). His glycated hemoglobin level is 5.3%. Should this elevated glucose level be treated?

Diagnosing delirium

Diagnosing delirium. JAMA. 2010;304(19):2125.

Radtke, FM, et al.

http://jama.ama-assn.org/content/304/19/2125.1.full

Dr Wong and colleagues​ provided a systematic review that included discussion of easy-to-use bedside instruments to detect delirium; such tools are paramount in early diagnosis and treatment. However, there are 2 important additional aspects that we would like to address.

(See previous post)

Does this patient have delirium?

Does this patient have delirium? JAMA. 2010;304(7):779-786.

Wong, CL, et al.

http://jama.ama-assn.org/content/304/7/779.abstract?ijkey=&keytype2=tf_ipsecsha

Delirium occurs in many hospitalized older patients and has serious consequences including increased risk for death and admission to long-term care. Despite its importance, health care clinicians often fail to recognize delirium. Simple bedside instruments may lead to improved identification.