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Effect of an intensive glucose management protocol on the mortality of critically ill adult patients.
Mayo Clin Proc. 2004 Aug; 79(8):992-1000.MC

Abstract

OBJECTIVE

To assess the effect of an intensive glucose management protocol in a heterogeneous population of critically ill 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 a 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 ill adult patients. These results support the adoption of this low-cost intervention as a standard of care for critically ill patients.

Authors+Show Affiliations

Critical Care Unit, The Stamford Hospital, Stamford, Conn 06902, USA. Jkrinsley@stamhealth.org

Pub Type(s)

Clinical Trial
Controlled Clinical Trial
Journal Article

Language

eng

PubMed ID

15301325

Citation

Krinsley, James Stephen. "Effect of an Intensive Glucose Management Protocol On the Mortality of Critically Ill Adult Patients." Mayo Clinic Proceedings, vol. 79, no. 8, 2004, pp. 992-1000.
Krinsley JS. Effect of an intensive glucose management protocol on the mortality of critically ill adult patients. Mayo Clin Proc. 2004;79(8):992-1000.
Krinsley, J. S. (2004). Effect of an intensive glucose management protocol on the mortality of critically ill adult patients. Mayo Clinic Proceedings, 79(8), 992-1000.
Krinsley JS. Effect of an Intensive Glucose Management Protocol On the Mortality of Critically Ill Adult Patients. Mayo Clin Proc. 2004;79(8):992-1000. PubMed PMID: 15301325.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of an intensive glucose management protocol on the mortality of critically ill adult patients. A1 - Krinsley,James Stephen, PY - 2004/8/11/pubmed PY - 2004/8/21/medline PY - 2004/8/11/entrez SP - 992 EP - 1000 JF - Mayo Clinic proceedings JO - Mayo Clin Proc VL - 79 IS - 8 N2 - OBJECTIVE: To assess the effect of an intensive glucose management protocol in a heterogeneous population of critically ill 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 a 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 ill adult patients. These results support the adoption of this low-cost intervention as a standard of care for critically ill patients. SN - 0025-6196 UR - https://www.unboundmedicine.com/medline/citation/15301325/Effect_of_an_intensive_glucose_management_protocol_on_the_mortality_of_critically_ill_adult_patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0025-6196(11)62572-X DB - PRIME DP - Unbound Medicine ER -