Insulin infusion protocols for critically ill patients: a highlight of differences and similarities.
OBJECTIVE
To discuss the major differences and similarities among the currently published insulin infusion protocols (IIPs) for critically ill patients.


METHODS
IIPs were identified by searching MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials. The reference lists for all retrieved protocols were also reviewed to identify any IIPs that were not surfaced with use of our initial search strategies. The major differences and similarities among the IIPs were identified and examined. In addition, strategies for successful implementation of IIPs were outlined.


RESULTS
Our search strategies retrieved 17 IIPs. Currently, no published studies have compared one insulin protocol with another. The major differences or similarities among the published IIPs were in the following areas: patient characteristics, target glucose level, time to achieve target glucose level, incidence of hypoglycemia, rationale for adjusting the rates of insulin infusion, and methods of blood glucose measurements. Because of variations in the definition of hypoglycemia, methods of blood glucose measurement, and types of blood samples used, some comparisons across the protocols were difficult. Use of a multidisciplinary team and gaining administrative support are crucial for addressing issues and provision of necessary resources for implementing a protocol for "tight" glycemic control in critically ill patients.


CONCLUSIONS
Clinicians should evaluate the type of patients in their critical care units, the mean baseline glucose levels, and the available resources to determine the most appropriate and practical IIP for their institution.
Nazer
Lama H
LH
Western University of Health Sciences, Pomona, California 91766-1854, USA.
Chow
Sheryl L
SL
Moghissi
Etie S
ES
D018849:Controlled Clinical Trials as Topic; D016638:Critical Illness / Q000628:therapy*; D016206:Databases, Bibliographic; D006801:Humans; D007003:Hypoglycemia / Q000188:drug therapy; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D007332:Insulin Infusion Systems; D016239:MEDLINE
D007004:Hypoglycemic Agents; D007328:Insulin