TITLE

Effect of an Intensive Glucose Management Protocol on the Mortality of Critically Ill Adult Patients

AUTHOR(S)
Krinsley, James Stephen
PUB. DATE
August 2004
SOURCE
Mayo Clinic Proceedings;Aug2004, Vol. 79 Issue 8, p992
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
OBJECTIVE: To assess the effect of an Intensive glucose management protocol In a heterogeneous population of critically III adult patients. PATIENTS AND METHODS: This study consisted of 800 consecutive patients admitted after Institution of the protocol (treatment group, between February 1, 2003, and January 10, 2004) and 800 patients admitted immediately preceding Institution of the protocol (baseline group, between February 23, 2002, and January 31, 2003). The setting was a 14-bed medical-surgical Intensive care unit (ICU} In a university-affiliated community teaching hospital. The protocol involved intensive monitoring and treatment to maintain plasma glucose values lower than 140 mg/dL. Continuous intravenous insulin was used if glucose values exceeded 200 mg/dL on 2 successive occasions. RESULTS: The 2 groups of patients were well matched, with similar age, sex, race, prevalence of diabetes mellitus, Acute Physiology and Chronic Health Evaluation II scores, and distribution of diagnoses. After institution of the protocol, the mean glucose value decreased from 152.3 to 130.7 mg/dL (P<.001), marked by a 56.3% reduction In the percentage of glucose values of 200 mg/dL or higher, without s significant change in hypoglycemia. The development of new renal Insufficiency decreased 75% (P=.03), and the number of patients undergoing transfusion of packed red blood cells decreased 18.7% (P=.04). Hospital mortality decreased 29.3% (P=-.002), and length of stay in the ICU decreased 10.8% (P=.01). CONCLUSION: The protocol resulted in significantly Improved glycemic control and was associated with decreased mortality, organ dysfunction, and length of stay In the ICU In a heterogeneous population of critically III adult patients. These results support the adoption of this low-cost Intervention as a standard of care for critically III patients.
ACCESSION #
14201612

 

Related Articles

  • Critical Care.  // Current Medical Literature: Diabetes;2011, Vol. 28 Issue 3, p105 

    The author discusses several research studies on the management of critically-ill diabetic patients. The author notes a study which analyzes the nursing practice patterns in aligning the activities of glucose monitoring and insulin administration. The author mentions a study which examines the...

  • Evaluation of lacrimal fluid as an alternative for monitoring glucose in critically ill patients. LeBlanc, Jaclyn; Haas, Curtis; Vicente, Glorimar; Colon, Luis // Intensive Care Medicine;Oct2005, Vol. 31 Issue 10, p1442 

    Objective: This study evaluated the use of lacrimal fluid glucose concentrations as a minimally invasive, alternative sampling strategy for monitoring glucose concentrations in surgical/trauma ICU patients. Design and setting: Prospective, paired sample study in an adult surgical/trauma ICU....

  • The responsibility of undertaking large randomized controlled trials. Preiser, Jean-Charles; Wernerman, Jan // Intensive Care Medicine;Feb2014, Vol. 40 Issue 2, p266 

    The authors discuss research on glucose monitoring and glucose control in critically ill patients. They reference the study "Tight Computerized Versus Conventional Glucose Control in the ICU: A Randomized Controlled Study" by P. Kalfon and colleagues published in the current issue of the...

  • Improved Postprandial Glycemic Control During Treatment With Humalog Mix25, a Novel... Roach, Paris; Yue, Lilly // Diabetes Care;Aug99, Vol. 22 Issue 8, p1258 

    Discusses a study which compared the Humalog Mix25 to human insulin 30/70 novel insulin lispro-protamine formulation (NPL) with respect to glycemic control. How the study was conducted; Results of the study; Discussion of the results.

  • Professional CGM management workflow. Watsky, Jay; Dluge-Aungst, Dawn // Endocrine Today;Feb2011, Vol. 9 Issue 2, p6 

    The authors discuss the use of professional continuous glucose monitoring (CGM) in insulin therapy.

  • Glucose control: how low should you go with the critically ill? Zolotor, Adam J.; Schumann, Sarah-Anne; Vargish, Lisa; Hickner, John // Journal of Family Practice;Aug2009, Vol. 58 Issue 8, p424 

    For hyperglycemic patients admitted to an intensive care unit (ICU), the target blood glucose level should be < or =180 mg/dL, not 81 to 108 mg/dL. More aggressive glucose lowering is associated with a higher mortality rate.

  • Glycemic Control Protocol for Adult Intensive Care. Pisupati, Radhika; Wojcik, Janice // Hospital Pharmacy;Oct2006, Vol. 41 Issue 10, p1000 

    The article focuses on the adoption of glycemic control protocol for patients in intensive care units by the Saint Joseph's Regional Medical Center in Paterson, New Jersey. It has been proved through a clinical trial that maintaining tight glycemic control can increase insulin infusion and...

  • Computer-assisted glucose control in critically ill patients. Vogelzang, Mathijs; Loef, Bert G.; Regtien, Joost G.; Van der Horst, Iwan C. C.; Van Assen, Hein; Zijlstra, Felix; Nijsten, Maarten W. N. // Intensive Care Medicine;Aug2008, Vol. 34 Issue 8, p1421 

    Intensive insulin therapy is associated with the risk of hypoglycemia and increased costs of material and personnel. We therefore evaluated the safety and efficiency of a computer-assisted glucose control protocol in a large population of critically ill patients. Observational cohort study in...

  • How Big of a Problem Is Glycemic Control and What Is the Best Way to Handle It? Marshall, Adriene // Pulmonary Reviews;Mar2011, Vol. 16 Issue 3, p17 

    The article reports on the understated receiving of continuous insulin infusions by intensive care unit (ICU) patients with hypoglycemia and the strategies to maintain glycemic control. Based on studies, insulin is a high risk medication and its safe administration is imperative for all health...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics