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Intensive glycemic management in critically ill patients.
Jt Comm J Qual Patient Saf. 2005 Jun; 31(6):308-12.JC

Abstract

BACKGROUND

The effect of an intensive glycemic management protocol was assessed in a heterogeneous population of critically ill adult patients.

METHODS

Patients representing 800 consecutive admissions following the institution of the protocol were compared with the 800 admissions immediately preceding the institution of the protocol in a 14-bed mixed medical-surgical intensive care unit (ICU). The protocol used intensive monitoring and treatment to maintain blood glucose values >140 mg/dl. Continuous intravenous insulin was used if glucose values were >200 mg/dl on two successive occasions.

RESULTS

Mean glucose decreased from 152.3 mg/dl to 130.7 mg/dl (p < .001), marked by a 56.3% reduction in the percentage of glucose values > or =200 mg/dl, without a significant change in hypoglycemia. There were decreases in the development of new renal insufficiency (p = .034) and in the number of patients receiving transfusion of packed red blood cells (p = .035) during the protocol period. Hospital mortality decreased 29.3% (p = .002), and ICU length of stay decreased 10.8% (p = .011) after institution of the protocol.

DISCUSSION

The 29.3% relative reduction in hospital mortality seen among the treatment patients following institution of the protocol probably exceeded the expectations of the initiative's champions. The culture of the ICU regarding glycemic control changed definitively. The protocol was extended to an intermediate care unit, resulting in improvement in glycemic control without an increase in hypoglycemia.

Authors+Show Affiliations

The Stamford Hospital, Connecticut, USA. jkrinsley@stamhealth.orgNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15999958

Citation

Krinsley, James, and Brian Grissler. "Intensive Glycemic Management in Critically Ill Patients." Joint Commission Journal On Quality and Patient Safety, vol. 31, no. 6, 2005, pp. 308-12.
Krinsley J, Grissler B. Intensive glycemic management in critically ill patients. Jt Comm J Qual Patient Saf. 2005;31(6):308-12.
Krinsley, J., & Grissler, B. (2005). Intensive glycemic management in critically ill patients. Joint Commission Journal On Quality and Patient Safety, 31(6), 308-12.
Krinsley J, Grissler B. Intensive Glycemic Management in Critically Ill Patients. Jt Comm J Qual Patient Saf. 2005;31(6):308-12. PubMed PMID: 15999958.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intensive glycemic management in critically ill patients. AU - Krinsley,James, AU - Grissler,Brian, PY - 2005/7/8/pubmed PY - 2005/10/6/medline PY - 2005/7/8/entrez SP - 308 EP - 12 JF - Joint Commission journal on quality and patient safety JO - Jt Comm J Qual Patient Saf VL - 31 IS - 6 N2 - BACKGROUND: The effect of an intensive glycemic management protocol was assessed in a heterogeneous population of critically ill adult patients. METHODS: Patients representing 800 consecutive admissions following the institution of the protocol were compared with the 800 admissions immediately preceding the institution of the protocol in a 14-bed mixed medical-surgical intensive care unit (ICU). The protocol used intensive monitoring and treatment to maintain blood glucose values >140 mg/dl. Continuous intravenous insulin was used if glucose values were >200 mg/dl on two successive occasions. RESULTS: Mean glucose decreased from 152.3 mg/dl to 130.7 mg/dl (p < .001), marked by a 56.3% reduction in the percentage of glucose values > or =200 mg/dl, without a significant change in hypoglycemia. There were decreases in the development of new renal insufficiency (p = .034) and in the number of patients receiving transfusion of packed red blood cells (p = .035) during the protocol period. Hospital mortality decreased 29.3% (p = .002), and ICU length of stay decreased 10.8% (p = .011) after institution of the protocol. DISCUSSION: The 29.3% relative reduction in hospital mortality seen among the treatment patients following institution of the protocol probably exceeded the expectations of the initiative's champions. The culture of the ICU regarding glycemic control changed definitively. The protocol was extended to an intermediate care unit, resulting in improvement in glycemic control without an increase in hypoglycemia. SN - 1553-7250 UR - https://www.unboundmedicine.com/medline/citation/15999958/Intensive_glycemic_management_in_critically_ill_patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1553-7250(05)31039-7 DB - PRIME DP - Unbound Medicine ER -