OBJECTIVE: Intensive insulin therapy to normalize blood glucose may improve outcome in intensive care unit patients. We prospectively evaluated the implementation of an intensive insulin protocol in medical intensive care patients to identify and overcome obstacles that this complex therapy creates. DESIGN: This prospective, quality assessment study was designed to establish a standard protocol for glucose control in critically ill patients. SETTING: The study took place in the medical intensive care unit at the Medical University of South Carolina, a tertiary care center. PATIENTS: Patients diagnosed with sepsis and two consecutive blood glucose measurements of >120 mg/dL were included in the study. INTERVENTIONS: The protocol, targeting blood glucose of 80-120 mg/dL, was a multidisciplinary initiative involving extensive education of house staff before subject enrollment. Based on predefined criteria, patients were monitored daily for glycemic control, inclusion criteria, and protocol adherence. Protocol improvements were assessed at 6 and 12 months via nursing surveys. MEASUREMENTS AND MAIN RESULTS: Seventy patients receiving insulin infusion for >8 hrs were included in data analysis, accounting for 4,920 glucose readings. Eighty-six hypoglycemic events were recorded, with the number of events decreasing from 7.6% to 0.3% by the final version of the protocol. Average duration on protocol was 6 days, and average time to target range was 5.4 hrs. Identifiable causes of hypoglycemia and survey results led to four protocol revisions by study completion. CONCLUSIONS: In comparison to studies suggesting that normoglycemia is an easily achievable goal, our protocol often recorded glucose values <80 mg/dL, although values <60 mg/dL were rare and usually due to protocol violations. In the interval before automated glucose-sensing insulin infusion devices become available for the intensive care unit, the current protocol is available to assist others in achieving target glucose levels shown to improve mortality rate in an intensive care unit population.
OBJECTIVE: Intensive insulin therapy to normalize blood glucose may improve outcome in intensive care unit patients. We prospectively evaluated the implementation of an intensive insulin protocol in medical intensive care patients to identify and overcome obstacles that this complex therapy creates. DESIGN: This prospective, quality assessment study was designed to establish a standard protocol for glucose control in critically ill patients. SETTING: The study took place in the medical intensive care unit at the Medical University of South Carolina, a tertiary care center. PATIENTS: Patients diagnosed with sepsis and two consecutive blood glucose measurements of >120 mg/dL were included in the study. INTERVENTIONS: The protocol, targeting blood glucose of 80-120 mg/dL, was a multidisciplinary initiative involving extensive education of house staff before subject enrollment. Based on predefined criteria, patients were monitored daily for glycemic control, inclusion criteria, and protocol adherence. Protocol improvements were assessed at 6 and 12 months via nursing surveys. MEASUREMENTS AND MAIN RESULTS: Seventy patients receiving insulin infusion for >8 hrs were included in data analysis, accounting for 4,920 glucose readings. Eighty-six hypoglycemic events were recorded, with the number of events decreasing from 7.6% to 0.3% by the final version of the protocol. Average duration on protocol was 6 days, and average time to target range was 5.4 hrs. Identifiable causes of hypoglycemia and survey results led to four protocol revisions by study completion. CONCLUSIONS: In comparison to studies suggesting that normoglycemia is an easily achievable goal, our protocol often recorded glucose values <80 mg/dL, although values <60 mg/dL were rare and usually due to protocol violations. In the interval before automated glucose-sensing insulin infusion devices become available for the intensive care unit, the current protocol is available to assist others in achieving target glucose levels shown to improve mortality rate in an intensive care unit population.
Authors: Roman Kulnik; Johannes Plank; Christoph Pachler; Malgorzata E Wilinska; Andrea Groselj-Strele; Doris Röthlein; Matthias Wufka; Norman Kachel; Karl Heinz Smolle; Sabine Perl; Thomas Rudolf Pieber; Roman Hovorka; Martin Ellmerer Journal: J Diabetes Sci Technol Date: 2008-11
Authors: Luciana Vládia Carvalhêdo Fragoso; Márcio Flávio Moura de Araújo; Lidianne Fernandes da Silva Lobo; Dirk Schreen; Maria Lúcia Zanetti; Marta Maria Coelho Damasceno Journal: Einstein (Sao Paulo) Date: 2022-06-01
Authors: Christoph Pachler; Johannes Plank; Heinz Weinhandl; Ludovic J Chassin; Malgorzata E Wilinska; Roman Kulnik; Peter Kaufmann; Karl-Heinz Smolle; Ernst Pilger; Thomas R Pieber; Martin Ellmerer; Roman Hovorka Journal: Intensive Care Med Date: 2008-02-23 Impact factor: 17.440
Authors: Iakovos Nomikos; Maria Kyriazi; Dimitra Vamvakopoulou; Andreas Sidiropoulos; Athanasios Apostolou; Aspasia Kyritsaka; Evangelos Athanassiou; Nikolaos C Vamvakopoulos Journal: J Clin Med Res Date: 2012-07-20
Authors: Regula Meier; Markus Béchir; Silke Ludwig; Jutta Sommerfeld; Marius Keel; Peter Steiger; Reto Stocker; John F Stover Journal: Crit Care Date: 2008-08-04 Impact factor: 9.097