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Objectives: Diabetes mellitus has been associated with greater difficulty of tracheal intubation in the operating room. This relationship has not been examined for tracheal intubation of critically ill adults. We examined whether diabetes mellitus was independently associated with the time from induction of anesthesia to intubation of the trachea among critically ill adults., Design: A secondary analysis of data from five randomized trials completed by the Pragmatic Critical Care Research Group (PCCRG)., Setting: Emergency departments (EDs) or ICUs at 11 centers across the United States that enrolled in randomized trials of a pre-intubation checklist, fluid bolus administration, bag-mask ventilation between induction and laryngoscopy, and intubation using a bougie vs. stylet., Patients: Critically ill adults undergoing tracheal intubation with a laryngoscope in an ED or an ICU., Interventions: None., Measurements and Main Results: A total of 2654 patients were included in this analysis, of whom 638 (24.0%) had diabetes mellitus. The mean time from induction of anesthesia to intubation of the trachea was 169 seconds (sd, 137s). Complications occurred during intubation in 1007 patients (37.9%). Diabetes mellitus was not associated with the time from induction of anesthesia to intubation of the trachea (-4.4 s compared with nondiabetes; 95% CI, -17.2 to 8.3 s; p = 0.50). Use of a video vs. direct laryngoscope did not modify the association between diabetes mellitus and the time from induction to intubation (p for interaction = 0.064). Diabetes mellitus was not associated with the probability of successful intubation on the first attempt (85.6% vs. 84.3%; p = 0.46) or complications during intubation (39.8% vs. 37.4%; p = 0.52)., Conclusions: Among 2654 critically ill patients undergoing tracheal intubation in an ED or an ICU, diabetes mellitus was not independently associated with the time from induction to intubation, the probability of successful intubation on the first attempt, or the rate of complications during intubation., Competing Interests: Dr. Krause was supported in part by grants from the National Institutes of Health (NIH)/National Institute on Deafness and Other Communication Disorders and NIH/National Institute of Neurological Disorders and Stroke. Dr. de Jong reports receiving remuneration for presentations from Medtronic, Sedana, Drager, Viatris, Sanofi, and Fisher & Paykel. Dr. Casey was supported in part by grants from the NIH/National Center for Advancing Translational Sciences (NCATS), the NIH/National Heart, Lung, and Blood Institute (NHLBI), the Department of Defense, and the Patient-Centered Outcomes Research Institute. Dr. Casey reported having received a travel grant from Fischer and Paykel. Dr. Ginde was supported by grants from the Department of Defense related to the current work, and grants from NIH and Centers for Disease Control and Prevention and consulting fees from Seastar and Biomeme, unrelated to the current work. Dr. Hughes was supported in part by the NIH (AG061161, AG080420, AG053582, GM120484, HL151951, and HL164909). Dr. Hughes has received consulting fees from Sedana Medical as members of their U.S. Trials Steering Committee. Dr. Khan has received grant support from Dompe Pharmaceuticals, 4D Medical, Eli Lilly, United Therapeutics, and NIH/NHLBI. Dr. Mitchell received travel-related funding support for a research trial from Sharpmed. Dr. Semler was support in part by grants from the NIH/NCATS, the NIH/NHLBI, the Department of Defense, and the Patient-Centered Outcomes Research Institute. Dr. Semler reported having received compensation from Baxter Healthcare Corporation for having delivered a virtual lecture at a conference and for having served on a medical advisory board. The remaining authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2024 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)

Competing Interests: Dr. Umpierrez’s institution received funding from Dexcom, Abbott, Bayer, and Astra Zeneca. Dr. Sirimaturos’ institution received funding from Grifols; he received funding from Astra Zeneca. Dr. Mechanick received funding from Abbott Nutrition, Aveta.Life, and Twin Health. Dr. Irving disclosed that she is an American Society of Parenteral and Enteral Nutrition (ASPEN) board member and author on Society of Critical Care Medicine/ASPEN guidelines for pediatric nutrition support. Dr. Preiser received funding from Edwards, Glysure, Medtronic, and Optiscan. Dr. Krinsley received funding from Dexcom. Dr. Sands received funding from BioXcel Therapeutics. Dr. Jacobi disclosed that she is an Advisory Board Member of the Pfizer Hospital Business Unit. Dr. Agus’ institution received funding from the National Institutes of Health; he disclosed that Dexcom is providing in kind support with continuous glucose monitors for a clinical trial in children. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Rationale: Maintaining glycemic control of critically ill patients may impact outcomes such as survival, infection, and neuromuscular recovery, but there is equipoise on the target blood levels, monitoring frequency, and methods., Objectives: The purpose was to update the 2012 Society of Critical Care Medicine and American College of Critical Care Medicine (ACCM) guidelines with a new systematic review of the literature and provide actionable guidance for clinicians., Panel Design: The total multiprofessional task force of 22, consisting of clinicians and patient/family advocates, and a methodologist applied the processes described in the ACCM guidelines standard operating procedure manual to develop evidence-based recommendations in alignment with the Grading of Recommendations Assessment, Development, and Evaluation Approach (GRADE) methodology. Conflict of interest policies were strictly followed in all phases of the guidelines, including panel selection and voting., Methods: We conducted a systematic review for each Population, Intervention, Comparator, and Outcomes question related to glycemic management in critically ill children (≥ 42 wk old adjusted gestational age to 18 yr old) and adults, including triggers for initiation of insulin therapy, route of administration, monitoring frequency, role of an explicit decision support tool for protocol maintenance, and methodology for glucose testing. We identified the best available evidence, statistically summarized the evidence, and then assessed the quality of evidence using the GRADE approach. We used the evidence-to-decision framework to formulate recommendations as strong or weak or as a good practice statement. In addition, "In our practice" statements were included when the available evidence was insufficient to support a recommendation, but the panel felt that describing their practice patterns may be appropriate. Additional topics were identified for future research., Results: This guideline is an update of the guidelines for the use of an insulin infusion for the management of hyperglycemia in critically ill patients. It is intended for adult and pediatric practitioners to reassess current practices and direct research into areas with inadequate literature. The panel issued seven statements related to glycemic control in unselected adults (two good practice statements, four conditional recommendations, one research statement) and seven statements for pediatric patients (two good practice statements, one strong recommendation, one conditional recommendation, two "In our practice" statements, and one research statement), with additional detail on specific subset populations where available., Conclusions: The guidelines panel achieved consensus for adults and children regarding a preference for an insulin infusion for the acute management of hyperglycemia with titration guided by an explicit clinical decision support tool and frequent (≤ 1 hr) monitoring intervals during glycemic instability to minimize hypoglycemia and against targeting intensive glucose levels. These recommendations are intended for consideration within the framework of the patient's existing clinical status. Further research is required to evaluate the role of individualized glycemic targets, continuous glucose monitoring systems, explicit decision support tools, and standardized glycemic control metrics., Competing Interests: Dr. Umpierrez’s institution received funding from Dexcom, Abbott, Bayer, and Astra Zeneca. Dr. Sirimaturos’ institution received funding from Grifols; he received funding from Astra Zeneca. Dr. Mechanick received funding from Abbott Nutrition, Aveta.Life, and Twin Health. Dr. Irving disclosed that she is a board member of the American Society for Parenteral and Enteral Nutrition and a member of American Society for Parenteral and Enteral Nutrition/Society of Critical Care Medicine Pediatric Critical Care Nutrition Guideline. Dr. Preiser received funding from Edwards, Glysure, Medtronic, and Optiscan. Dr. Krinsley received funding from Dexcom. Dr. Sands received funding from BioXcel Therapeutics. Dr. Jacobi disclosed that she was an Advisory Board Member of the Pfizer Hospital Business Unit. Dr. Agus’ institution received funding from the National Institutes of Health; he disclosed that Dexcom is providing in kind support with continuous glucose monitors for a clinical trial in children. The remaining authors have disclosed that they do not have any potential conflicts of interest. The total multiprofessional task force of 22, consisting of clinicians and patient/family advocates, and a methodologist applied the processes described in the ACCM guidelines standard operating procedure manual to develop evidence-based recommendations in alignment with the Grading of Recommendations Assessment, Development, and Evaluation Approach (GRADE) methodology. Conflict of interest policies were strictly followed in all phases of the guidelines, including panel selection and voting., (Copyright © 2024 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)