This Article Full Text Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Kanji, S Articles by Tierney, M Search for Related Content PubMed Articles by Kanji, S Articles by Tierney, M Social Bookmarking                         What's this?

Standardization of IV Insulin Therapy Improves the Efficiency and Safety of Blood Glucose Control in Critically Ill Adults

Department of Pharmacy, Critical Care, Endocrinology, Ottawa Hospital, General Campus and The Ottawa Health Research Institute, Ottawa, Ontario, Canada

Objective: Aggressive glycemic control improves mortality and morbidity in critically ill adults; however, implementation of such a strategy can be logistically difficult. This study evaluates the efficiency and safety of a nurse-managed insulin protocol in critically ill adults. Design: Combined retrospective-prospective before-after cohort study. Setting: Twenty-one bed medical/surgical intensive care unit (ICU) in a tertiary care hospital. Patients: Two cohorts of 50 consecutive ICU patients requiring insulin infusions. Intervention: Patients in the control cohort received insulin infusions titrated according to target blood glucose ranges and sliding scales at the physician's discretion. Patients in the interventional cohort received an insulin infusion adjusted using a standardized protocol targeting a blood glucose of 4.5 to 6.1 mmol/L (81 to 110 mg/dL). Measurements and main results: Efficiency was measured by comparing the time to reach, and the time spent within, the target range between cohorts. Safety was assessed by comparing the incidence of severe hypoglycemia, the frequency of rescue dextrose administration, and the cumulative time that the infusion was held for hypoglycemia between cohorts. Patients in the interventional cohort reached their target more rapidly (11.3 ± 7.9 vs 16.4 ± 12.6 hours; p = .028) and maintained their blood glucose within the target range longer (11.5 ± 3.7 vs 7.1 ± 5.0 hours/day; p < .001) than controls. The standardized protocol yielded a 4-fold reduction in the incidence of severe hypoglycemia (4 vs 16%; p = .046) and reduced the median frequency of dextrose rescue therapy (0 [0 to 0.91] vs 0.17 [0 to 1.2] episodes/patient per day; p = .01) as compared with controls. Conclusion: Standardization of intensive insulin therapy improves the efficiency and safety of glycemic control in critically ill adults.

Nutrition in Clinical Practice, Vol. 19, No. 6, 646-647 (2004)
DOI: 10.1177/0115426504019006646


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?