Background: Glycemic control in burn patients is critical for reducing infection and mortality. Objective: This study was conducted to assess the incidence and outcomes of hypoglycemia during continuous insulin infusions (CII). Methods: This institutional review board-approved study was a retrospective, single burn center, electronic chart review. Patients admitted between January 1, 2013, and October 31, 2014, who received a CII were included. Patients with incomplete data or who received <24 hours of CII were excluded. Results: Thirty-eight patients met inclusion criteria; 6 were excluded. The average patient was a 52-year-old Caucasian male with a 33% total body surface area burn and an acute physiology and chronic health evaluation (APACHE) II score of 20.Hypoglycemia was present for 87 of 6540 hours of CII therapy (1.1%). Two-thirds experienced a serum glucose <70 mg/dL and half <60 mg/dL. The most commonly assessed reasons for the hypoglycemic episodes were protocol violations (47%) and glucose variability (30%). After multivariable logistic regression, only history of diabetes remained a statistically significant risk factor with an odds ratio of 15.4 (95% confidence interval: 2.5-95.1). Four different CII protocols were prescribed. All protocols had a high glucose variability, as assessed by hours / day within goal range (13.1 ± 2.5, 14.1 ± 3.1, 14.3 ± 2.4, 9.8; P = .282). Conclusion: The amount of different protocols likely contributed to protocol violations and glucose variability. Our data demonstrate the need to create and consolidate usage to a single protocol in attempts to improve glycemic control.
Background: Glycemic control in burn patients is critical for reducing infection and mortality. Objective: This study was conducted to assess the incidence and outcomes of hypoglycemia during continuous insulin infusions (CII). Methods: This institutional review board-approved study was a retrospective, single burn center, electronic chart review. Patients admitted between January 1, 2013, and October 31, 2014, who received a CII were included. Patients with incomplete data or who received <24 hours of CII were excluded. Results: Thirty-eight patients met inclusion criteria; 6 were excluded. The average patient was a 52-year-old Caucasian male with a 33% total body surface area burn and an acute physiology and chronic health evaluation (APACHE) II score of 20.Hypoglycemia was present for 87 of 6540 hours of CII therapy (1.1%). Two-thirds experienced a serum glucose <70 mg/dL and half <60 mg/dL. The most commonly assessed reasons for the hypoglycemic episodes were protocol violations (47%) and glucose variability (30%). After multivariable logistic regression, only history of diabetes remained a statistically significant risk factor with an odds ratio of 15.4 (95% confidence interval: 2.5-95.1). Four different CII protocols were prescribed. All protocols had a high glucose variability, as assessed by hours / day within goal range (13.1 ± 2.5, 14.1 ± 3.1, 14.3 ± 2.4, 9.8; P = .282). Conclusion: The amount of different protocols likely contributed to protocol violations and glucose variability. Our data demonstrate the need to create and consolidate usage to a single protocol in attempts to improve glycemic control.
Authors: Roland N Dickerson; Leslie A Hamilton; Kathryn A Connor; George O Maish; Martin A Croce; Gayle Minard; Rex O Brown Journal: Nutrition Date: 2010-10-25 Impact factor: 4.008
Authors: Simon Finfer; Dean R Chittock; Steve Yu-Shuo Su; Deborah Blair; Denise Foster; Vinay Dhingra; Rinaldo Bellomo; Deborah Cook; Peter Dodek; William R Henderson; Paul C Hébert; Stephane Heritier; Daren K Heyland; Colin McArthur; Ellen McDonald; Imogen Mitchell; John A Myburgh; Robyn Norton; Julie Potter; Bruce G Robinson; Juan J Ronco Journal: N Engl J Med Date: 2009-03-24 Impact factor: 91.245
Authors: Juliet J Ray; Jonathan P Meizoso; Casey J Allen; Laura F Teisch; Ethan Y Yang; Han Yao Foong; Leela S Mundra; Nicholas Namias; Louis R Pizano; Carl I Schulman Journal: J Burn Care Res Date: 2017 Mar/Apr Impact factor: 1.845
Authors: Claire V Murphy; Rebecca Coffey; Charles H Cook; Anthony T Gerlach; Sidney F Miller Journal: J Burn Care Res Date: 2011 Nov-Dec Impact factor: 1.845
Authors: Cornelia W E Hoedemaekers; Jacqueline M T Klein Gunnewiek; Marieke A Prinsen; Johannes L Willems; Johannes G Van der Hoeven Journal: Crit Care Med Date: 2008-11 Impact factor: 7.598
Authors: Gerd G Gauglitz; David N Herndon; Gabriela A Kulp; Walter J Meyer; Marc G Jeschke Journal: J Clin Endocrinol Metab Date: 2009-02-24 Impact factor: 5.958
Authors: Christopher H Pham; Sebastian Q Vrouwe; Karen Tsai; Li Ding; Zachary J Collier; Andrea C Grote; Trevor E Angell; Warren L Garner; T Justin Gillenwater; Haig A Yenikomshian Journal: J Crit Care Date: 2021-03-24 Impact factor: 4.298