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A randomized controlled trial comparing a computer-assisted insulin infusion protocol with a strict and a conventional protocol for glucose control in critically ill patients.
J Crit Care. 2009 Sep; 24(3):371-8.JC

Abstract

PURPOSE

The objective of this study is to evaluate blood glucose (BG) control efficacy and safety of 3 insulin protocols in medical intensive care unit (MICU) patients.

METHODS

This was a multicenter randomized controlled trial involving 167 MICU patients with at least one BG measurement >or=150 mg/dL and one or more of the following: mechanical ventilation, systemic inflammatory response syndrome, trauma, or burns. The interventions were computer-assisted insulin protocol (CAIP), with insulin infusion maintaining BG between 100 and 130 mg/dL; Leuven protocol, with insulin maintaining BG between 80 and 110 mg/dL; or conventional treatment-subcutaneous insulin if glucose >150 mg/dL. The main efficacy outcome was the mean of patients' median BG, and the safety outcome was the incidence of hypoglycemia (<or=40 mg/dL).

RESULTS

The mean of patients' median BG was 125.0, 127.1, and 158.5 mg/dL for CAIP, Leuven, and conventional treatment, respectively (P = .34, CAIP vs Leuven; P < .001, CAIP vs conventional). In CAIP, 12 patients (21.4%) had at least one episode of hypoglycemia vs 24 (41.4%) in Leuven and 2 (3.8%) in conventional treatment (P = .02, CAIP vs Leuven; P = .006, CAIP vs conventional).

CONCLUSIONS

The CAIP is safer than and as effective as the standard strict protocol for controlling glucose in MICU patients. Hypoglycemia was rare under conventional treatment. However, BG levels were higher than with IV insulin protocols.

Authors+Show Affiliations

Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo 05652-000, Brazil. alexandrebiasi@hotmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19592202

Citation

Cavalcanti, Alexandre B., et al. "A Randomized Controlled Trial Comparing a Computer-assisted Insulin Infusion Protocol With a Strict and a Conventional Protocol for Glucose Control in Critically Ill Patients." Journal of Critical Care, vol. 24, no. 3, 2009, pp. 371-8.
Cavalcanti AB, Silva E, Pereira AJ, et al. A randomized controlled trial comparing a computer-assisted insulin infusion protocol with a strict and a conventional protocol for glucose control in critically ill patients. J Crit Care. 2009;24(3):371-8.
Cavalcanti, A. B., Silva, E., Pereira, A. J., Caldeira-Filho, M., Almeida, F. P., Westphal, G. A., Beims, R., Fernandes, C. C., Correa, T. D., Gouvea, M. R., & Eluf-Neto, J. (2009). A randomized controlled trial comparing a computer-assisted insulin infusion protocol with a strict and a conventional protocol for glucose control in critically ill patients. Journal of Critical Care, 24(3), 371-8. https://doi.org/10.1016/j.jcrc.2009.05.005
Cavalcanti AB, et al. A Randomized Controlled Trial Comparing a Computer-assisted Insulin Infusion Protocol With a Strict and a Conventional Protocol for Glucose Control in Critically Ill Patients. J Crit Care. 2009;24(3):371-8. PubMed PMID: 19592202.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A randomized controlled trial comparing a computer-assisted insulin infusion protocol with a strict and a conventional protocol for glucose control in critically ill patients. AU - Cavalcanti,Alexandre B, AU - Silva,Eliezer, AU - Pereira,Adriano J, AU - Caldeira-Filho,Milton, AU - Almeida,Francisca P, AU - Westphal,Glauco A, AU - Beims,Renate, AU - Fernandes,Caio C, AU - Correa,Thiago D, AU - Gouvea,Marcos R, AU - Eluf-Neto,José, Y1 - 2009/07/09/ PY - 2008/11/08/received PY - 2009/04/29/revised PY - 2009/05/06/accepted PY - 2009/7/14/entrez PY - 2009/7/14/pubmed PY - 2009/12/16/medline SP - 371 EP - 8 JF - Journal of critical care JO - J Crit Care VL - 24 IS - 3 N2 - PURPOSE: The objective of this study is to evaluate blood glucose (BG) control efficacy and safety of 3 insulin protocols in medical intensive care unit (MICU) patients. METHODS: This was a multicenter randomized controlled trial involving 167 MICU patients with at least one BG measurement >or=150 mg/dL and one or more of the following: mechanical ventilation, systemic inflammatory response syndrome, trauma, or burns. The interventions were computer-assisted insulin protocol (CAIP), with insulin infusion maintaining BG between 100 and 130 mg/dL; Leuven protocol, with insulin maintaining BG between 80 and 110 mg/dL; or conventional treatment-subcutaneous insulin if glucose >150 mg/dL. The main efficacy outcome was the mean of patients' median BG, and the safety outcome was the incidence of hypoglycemia (<or=40 mg/dL). RESULTS: The mean of patients' median BG was 125.0, 127.1, and 158.5 mg/dL for CAIP, Leuven, and conventional treatment, respectively (P = .34, CAIP vs Leuven; P < .001, CAIP vs conventional). In CAIP, 12 patients (21.4%) had at least one episode of hypoglycemia vs 24 (41.4%) in Leuven and 2 (3.8%) in conventional treatment (P = .02, CAIP vs Leuven; P = .006, CAIP vs conventional). CONCLUSIONS: The CAIP is safer than and as effective as the standard strict protocol for controlling glucose in MICU patients. Hypoglycemia was rare under conventional treatment. However, BG levels were higher than with IV insulin protocols. SN - 1557-8615 UR - https://www.unboundmedicine.com/medline/citation/19592202/A_randomized_controlled_trial_comparing_a_computer_assisted_insulin_infusion_protocol_with_a_strict_and_a_conventional_protocol_for_glucose_control_in_critically_ill_patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0883-9441(09)00115-4 DB - PRIME DP - Unbound Medicine ER -