Computer-assisted glucose control in critically ill patients

Mathijs Vogelzang, Bert G Loef, Joost G Regtien, Iwan C C van der Horst, Hein van Assen, Felix Zijlstra, Maarten W N Nijsten, Mathijs Vogelzang, Bert G Loef, Joost G Regtien, Iwan C C van der Horst, Hein van Assen, Felix Zijlstra, Maarten W N Nijsten

Abstract

Objective: Intensive insulin therapy is associated with the risk of hypoglycemia and increased costs of material and personnel. We therefore evaluated the safety and efficiency of a computer-assisted glucose control protocol in a large population of critically ill patients.

Design and setting: Observational cohort study in three intensive care units (32 beds) in a 1,300-bed university teaching hospital.

Patients: All 2,800 patients admitted to the surgical, neurosurgical, and cardiothoracic units; the study period started at each ICU after implementation of Glucose Regulation for Intensive Care Patients (GRIP), a freely available computer-assisted glucose control protocol.

Measurements and results: We analysed compliance in relation to recommended insulin pump rates and glucose measurement frequency. Patients were on GRIP-ordered pump rates 97% of time. Median measurement time was 5min late (IQR 20min early to 34 min late). Hypoglycemia was uncommon (7% of patients for mild hypoglycemia, < 3.5mmol/l; 0.86% for severe hypoglycemia, < 2.2 mmol/l). Our predefined target range (4.0-7.5 mmol/l) was reached after a median of 5.6 h (IQR 0.2-11.8) and maintained for 89% (70-100%) of the remaining stay at the ICU. The number of measurements needed was 5.9 (4.8-7.3) per patient per day. In-hospital mortality was 10.1%.

Conclusions: Our computer-assisted glucose control protocol provides safe and efficient glucose regulation in routine intensive care practice. A low rate of hypoglycemic episodes was achieved with a considerably lower number of glucose measurements than used in most other schemes.

Figures

Fig. 1
Fig. 1
Time chart of patient inclusion per ICU. The dark colored squares indicate a ‘run-in’ period. The patients treated by GRIP in these periods were not analyzed in this study
Fig. 2
Fig. 2
Median and interquartile range of glucose levels and insulin pump rates during the first 48 h of ICU stay

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Source: PubMed

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