Achieving durable glucose control in the intensive care unit without hypoglycaemia : a new practical IV insulin protocol

Diabetes/Metabolism Research and Reviews - Tập 23 Số 1 - Trang 49-55 - 2007
Michael Balkin1,2, Charles Mascioli1, Virginia Smith3, H. Al-Nachawati2, Sandeep Mehrishi2, Ghulam Saydain2, Helen Slone4, Joseph Alessandrini5, Lawrence W. Brown1
1Department of Medicine, Huntington Hospital, 270 Park Avenue, Huntington. New York, USA
2Department of Medicine, Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, New York, USA
3Division of Nursing, Huntington Hospital, 270 Park Avenue, Huntington, New York, USA
4Department of Medicine, South Jersey Regional Medical Center, 1505 West Sherman Avenue, Vineland, NJ, 08360, USA
5Department of Pharmacy, South Jersey Regional Medical Center, 1505 West Sherman Avenue, Vineland, NJ, 08360, USA

Tóm tắt

AbstractBackgroundHyperglycaemia occurs in a substantial portion of critically ill patients in our intensive care units. Near normalization of elevated blood glucose levels with IV insulin may improve outcome. However, currently published IV insulin protocol are not ideal; most are relatively complex and often result in hypoglycaemia. We designed a protocol that would be practical to use while incorporating the necessary complexities required to achieve good glucose control, coupled with a low incidence hypoglycaemia.MethodsThe essential part of the protocol is a matrix specifying the amount by which an insulin flow rate is to be changed. The intersection of the current and the previous blood glucose values on the matrix locates the appropriate cell containing the required change in insulin flow rate. No additional calculations or tables are required.ResultsThe initial glucose level obtained by blood glucose meter (BGM) averaged 253.5 ± 95.6 mg/dL and fell below 140 within 9.3 h on the protocol. The average BGM on the protocol was 133.5 ± 43.9 mg/dL. Only 0.09% of all glucose values were <40 mg/dL and insulin had to be held only 2.2% of the time on the protocol. Physician input was not required and nursing accuracy in applying the protocol was greater than 94%. This protocol has been adopted as the default IV insulin protocol for the NorthShore‐LIJ Health System and several other medical centers.ConclusionA practical IV insulin protocol that has been extensively tested is presented. The protocol has been implemented at multiple institutions indicating its ease of use and excellent results. Copyright © 2006 John Wiley & Sons, Ltd.

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Tài liệu tham khảo

10.2337/diacare.28.10.2551

10.1177/014860719802200277

10.1097/01.TA.0000162141.26392.07

10.1210/jcem.87.3.8341

10.1056/NEJMoa011300

10.1161/01.CIR.99.20.2626

10.4065/79.8.992

10.1067/mtc.2003.181

10.1097/01.CCM.0000117317.18092.E4

http://www.ihi.org/IHI/Topics/CriticalCare/Sepsis accessed 24 February 2006.

10.1056/NEJMoa052521

10.1213/01.ANE.0000121769.62638.EB

10.1097/01.CCM.0000045568.12881.10

10.2337/diacare.27.2.461

10.4158/EP.8.1.10

10.1007/s00134-004-2252-2

10.1053/j.jvca.2004.08.003

10.1016/S0003-4975(99)00014-4

10.1001/archinte.163.15.1825

10.4065/80.12.1546

10.2337/diacare.25.9.1597

10.1161/01.RES.87.9.746

10.1111/j.1365-2265.2006.02437.x

10.2337/diacare.28.10.2367

10.1079/PNS2002168

10.1016/j.nut.2005.06.013

10.2337/diacare.28.10.2418

10.1089/152091504774198034

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Diabetes/Metabolism Research and Reviews

Tập 23 Số 1

49-55

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