الفهرس 
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Abstract
Hyperglycemia in critical illness is known to be associated with worsened outcome in both diabetic & non diabetic patients in both medical & surgical patients. Poor outcomes includes increased mortality , increased noscomial infections, poor Glasgow coma scale after both traumatic brain injury & cerebrovascular stroke, higher incidence of major adverse cardiovascular events & cardiogenic shock in acute coronary syndromes patients.
Controlling hyperglycemia with intense insulin therapy (using intravenous insulin with a target on 80-110 mg/dl) was found to be associated with higher incidence of hypoglycemia and increased mortality. It is now recommended to use moderate glycemic control with target of 140-180 mg/dl.
Aim of the study:
This study aimed to investigate effect of glucose variability (as measured by standard deviation of mean blood glucose in the first 3 days ) in invasively ventilated mechanically ventilated patients.
Patients and methods :
Total of 87 patients admitted to Critical Care Department in Alexandria Main University Hospital fulfilled inclusion criteria (which were hyperglycemia > 180mg/dl & requiring invasive mechanical ventilation from the first day) during study period.
The patients were managed with standard protocol for management of mechanically ventilated patients & received intravenous insulin with a target blood glucose 140-180mg/dl. The following data were measured on admission APACHEII score ,blood sugar level & documentation of previous diabetic status .Glycated hemoglobin (HbA1c) was measured to differentiate stress hyperglycemia from undiagnosed diabetes. For each patient the mean and the standard deviation of blood glucose during first 72 hour was calculated & incidence of hypoglycemia was recorded.
At the end of the study we divided the patients retrospectively into survivors & non-survivors & the 2 groups were compared as regards : glycemic parameters (admission blood glucose, mean blood glucose in first 72 hours , standard deviation of mean blood glucose, incidence of hypoglycemia),APACHEII score. The 2 groups also were compared as regards duration of mechanical ventilation, length of ICU stay, incidence of hospitals acquired infection, vasopressor & inotropes use.
Results
1. The APACHEII score was lower in survivors compared with non-survivors
2. Admission ,mean, variability of blood glucose level was higher in non survivors in comparison to survivors
3. Lower incidence of hypoglycemia, hospital acquired infection, inotropes & vasopresssor use ,ICU stay in survivors compared to non survivors.