Postoperative problems: Edited by David Silverman and Stanley RosenbaumPerioperative glycemic management in 2011 paradigm shiftsMaerz, Linda L.a; Akhtar, Shamsuddinb Author Information aDepartment of Surgery, Section of Trauma, Surgical Critical Care and Surgical Emergencies bDepartment of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut, USA Correspondence to Shamsuddin Akhtar, MBBS, Associate Professor, Department of Anesthesiology, Yale University School of Medicine, 333 Cedar Street, Tompkins 3, New Haven, CT 06520, USATel: +1 203 785 2802; fax: +1 203 785 6664; e-mail: [email protected] Current Opinion in Critical Care: August 2011 - Volume 17 - Issue 4 - p 370-375 doi: 10.1097/MCC.0b013e328348beb7 Buy Metrics Abstract Purpose of review The publication of Van den Berghe's landmark study in 2001 supported the use of intensive insulin therapy (IIT) to target normoglycemia in the critically ill and triggered a new era in glycemic management in the perioperative period and in the ICU. In 2009, the normoglycemia in intensive care evaluation-survival using glucose algorithm regulation (NICE-SUGAR) trial demonstrated increased mortality and incidence of hypoglycemia in patients managed with IIT, resulting in a shift toward higher blood glucose targets in this patient population. This review distills clinically pertinent principles from the related literature published in the months since the NICE-SUGAR trial. Recent findings A target blood glucose level in the acute care setting supported by many of the pertinent societies and frequently quoted in the literature is 140–180 mg/dl. Hyperglycemia, hypoglycemia, and glucose variability are detrimental. Accurate and efficient glucose monitoring devices are essential. Insulin infusion protocols (IIPs) employed to achieve desired blood glucose targets must be individualized and validated for the ICU and institution in which they are being implemented. Summary Appropriate glycemic management in the acute care setting can be achieved by targeting a reasonable blood glucose range and employing specific and institutionally validated IIPs. © 2011 Lippincott Williams & Wilkins, Inc.