POINT COUNTERPOINT Are Tight Glycemic Targets Achieved Through Intensive Insulin Infusion Still Applicable in the Intensive Care Unit? THE “PRO ” SIDE

Clinical trials have shown that over 98 % of patients in the intensive care unit (ICU) require insulin therapy to maintain normoglycemia. 1-4 Hyperglycemia is associated with higher morbidity and mortality for patients with traumatic brain injuries, 5-7 sepsis, 8 hematologic malignancy, 9 and nondiabetic stroke. 10 Among those who have had myocardial infarction, hypoglycemia is associated with an increased risk of congestive heart failure and cardiogenic shock. 11 However, the use of intensive insulin therapy (IIT) to manage hyperglycemia in the ICU is a controversial topic. Although some studies have shown that IIT improves outcomes, recent trials have questioned the benefit of IIT in light of the potential for increased frequency of hypoglycemia. The question to be addressed here is: Does implementing IIT for all ICU patients improve outcomes