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Responses to critical illness, such as excessive inflammation and hyperglycemia, may trigger detrimental chain reactions that damage cellular proteins and organelles. Such responses to illness contribute to the risk of (nonresolving) multiple organ dysfunction and adverse outcome.

We studied autophagy as a bulk degradation pathway able to remove toxic protein aggregates and damaged organelles and how these are affected by preventing hyperglycemia with insulin during critical illness.

Patients participated in a randomized study, conducted at a university hospital surgical/medical intensive care unit.

We studied adult prolonged critically ill patients vs. controls.

Tolerating excessive hyperglycemia was compared with intensive insulin therapy targeting …