The impact of a normoglycemic management protocol on clinical outcomes in the trauma intensive care unit.
BACKGROUND
The purpose of this study was to determine if protocol-driven normoglycemic management in trauma patients affected glucose control, ventilator-associated pneumonia, surgical-site infection, and inpatient mortality.


METHODS
A prospective, consecutive-series, historically controlled study design evaluated protocol-driven normoglycemic management among trauma patients at Vanderbilt University Medical Center. Those mechanically ventilated > or =24 hours and > or =15 years of age were included. A glycemic-control protocol required insulin infusion therapy for glucose >110 mg/dL. Control patients included those who met criteria, were admitted the year preceding protocol implementation, and had hyperglycemia treated at the physician's discretion.


RESULTS
Eight hundred eighteen patients met study criteria; 383 were managed without protocol; 435 underwent protocol. The protocol group had lower glucose levels 7 of 14 days measured. After admission, both groups had mean daily glucose levels <150 mg/dL. No difference in pneumonia (31.6% vs 34.5%; p = .413), surgical infection (5.0% vs 5.7%; p = .645) or mortality (12.3% vs 13.1%; p = .722) occurred between groups. If one episode of blood glucose level was > or =150 mg/dL (n = 638; 78.0%), outcomes were worse: higher daily glucose levels for 14 days after admission (p < .001), pneumonia rates (35.9% vs 23.3%; p = .002), and mortality (14.6% vs 6.1%; p = .002). One or more days of glucose > or =150 mg/dL had a 2- to 3-fold increase in the odds of death. Protocol use in these patients was not associated with outcome improvement.


CONCLUSIONS
Protocol-driven management decreased glucose levels 7 of 14 days after admission without outcome change. One or more glucose levels > or =150 mg/dL were associated with worse outcome.
Collier
Bryan
B
Department of Biostatistics, Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center, 243 Medical Center South, 2100 Pierce Avenue, Nashville, TN 37212, USA. bryan.collier@vanderbilt.edu
Diaz
Jose
J
Forbes
Rachel
R
Morris
John
J
May
Addison
A
Guy
Jeffrey
J
Ozdas
Asli
A
Dupont
William
W
Miller
Richard
R
Jensen
Gordon
G
D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D002985:Clinical Protocols; D016638:Critical Illness; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006943:Hyperglycemia / Q000150:complications / Q000401:mortality / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D007902:Length of Stay; D008297:Male; D011014:Pneumonia / Q000453:epidemiology / Q000401:mortality; D011446:Prospective Studies; D012121:Respiration, Artificial; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000401:mortality; D014193:Trauma Centers; D016896:Treatment Outcome
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin