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An insulin infusion protocol in critically ill cardiothoracic surgery patients.
Ann Pharmacother. 2004 Jul-Aug; 38(7-8):1123-9.AP

Abstract

BACKGROUND

Critically ill cardiothoracic patients are prone to hyperglycemia and an increased risk of surgical site infections postoperatively. Aggressive insulin treatment is required to achieve tight glycemic control (TGC) and improve outcomes.

OBJECTIVE

To examine and report on the performance of an insulin infusion protocol to maintain TGC, defined as a blood glucose level of 80-150 mg/dL, in critically ill cardiothoracic surgical patients.

METHODS

A nurse-driven insulin infusion protocol was developed and initiated in postoperative cardiothoracic surgical intensive care patients with or without diabetes. In this before-after cohort study, 2 periods of measurement were performed: a 6-month baseline period prior to the initiation of the insulin infusion protocol (control group, n = 174) followed by a 6-month intervention period in which the protocol was used (TGC group, n = 168).

RESULTS

Findings showed percent and time of blood glucose measurements within the TGC range (control 47% vs TGC 61%; p = 0.001), AUC of glucose exposure >150 mg/dL versus time for the first 24 hours of the insulin infusion (control 28.4 vs TGC 14.8; p < 0.001), median time to blood glucose <150 mg/dL (control 9.4 h vs TGC 2.1 h; p < 0.001), and percent blood glucose <65 mg/dL as a marker for hypoglycemia (control 9.8% vs TGC 16.7%; NS).

CONCLUSIONS

An insulin infusion protocol designed to achieve a goal blood glucose range of 80-150 mg/dL efficiently and significantly improved TGC in critically ill postoperative cardiothoracic surgery patients without significantly increasing the incidence of hypoglycemia.

Authors+Show Affiliations

Department of Pharmacy Services, Henry Ford Hospital, Detroit, MI 48201-2689, USA. cximmer1@hfhs.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

15150382

Citation

Zimmerman, Christopher R., et al. "An Insulin Infusion Protocol in Critically Ill Cardiothoracic Surgery Patients." The Annals of Pharmacotherapy, vol. 38, no. 7-8, 2004, pp. 1123-9.
Zimmerman CR, Mlynarek ME, Jordan JA, et al. An insulin infusion protocol in critically ill cardiothoracic surgery patients. Ann Pharmacother. 2004;38(7-8):1123-9.
Zimmerman, C. R., Mlynarek, M. E., Jordan, J. A., Rajda, C. A., & Horst, H. M. (2004). An insulin infusion protocol in critically ill cardiothoracic surgery patients. The Annals of Pharmacotherapy, 38(7-8), 1123-9.
Zimmerman CR, et al. An Insulin Infusion Protocol in Critically Ill Cardiothoracic Surgery Patients. Ann Pharmacother. 2004 Jul-Aug;38(7-8):1123-9. PubMed PMID: 15150382.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - An insulin infusion protocol in critically ill cardiothoracic surgery patients. AU - Zimmerman,Christopher R, AU - Mlynarek,Mark E, AU - Jordan,Jack A, AU - Rajda,Carol A, AU - Horst,H Mathilda, Y1 - 2004/05/18/ PY - 2004/5/20/pubmed PY - 2004/10/7/medline PY - 2004/5/20/entrez SP - 1123 EP - 9 JF - The Annals of pharmacotherapy JO - Ann Pharmacother VL - 38 IS - 7-8 N2 - BACKGROUND: Critically ill cardiothoracic patients are prone to hyperglycemia and an increased risk of surgical site infections postoperatively. Aggressive insulin treatment is required to achieve tight glycemic control (TGC) and improve outcomes. OBJECTIVE: To examine and report on the performance of an insulin infusion protocol to maintain TGC, defined as a blood glucose level of 80-150 mg/dL, in critically ill cardiothoracic surgical patients. METHODS: A nurse-driven insulin infusion protocol was developed and initiated in postoperative cardiothoracic surgical intensive care patients with or without diabetes. In this before-after cohort study, 2 periods of measurement were performed: a 6-month baseline period prior to the initiation of the insulin infusion protocol (control group, n = 174) followed by a 6-month intervention period in which the protocol was used (TGC group, n = 168). RESULTS: Findings showed percent and time of blood glucose measurements within the TGC range (control 47% vs TGC 61%; p = 0.001), AUC of glucose exposure >150 mg/dL versus time for the first 24 hours of the insulin infusion (control 28.4 vs TGC 14.8; p < 0.001), median time to blood glucose <150 mg/dL (control 9.4 h vs TGC 2.1 h; p < 0.001), and percent blood glucose <65 mg/dL as a marker for hypoglycemia (control 9.8% vs TGC 16.7%; NS). CONCLUSIONS: An insulin infusion protocol designed to achieve a goal blood glucose range of 80-150 mg/dL efficiently and significantly improved TGC in critically ill postoperative cardiothoracic surgery patients without significantly increasing the incidence of hypoglycemia. SN - 1060-0280 UR - https://www.unboundmedicine.com/medline/citation/15150382/An_insulin_infusion_protocol_in_critically_ill_cardiothoracic_surgery_patients_ L2 - https://journals.sagepub.com/doi/10.1345/aph.1E018?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -