Morbidity reduction in critically ill trauma patients through use of a computerized insulin infusion protocol: a preliminary study.
BACKGROUND
Recent data have demonstrated that intensive glycemic control during critical illness improves outcome. The purpose of our study was to evaluate the effect of a computerized hospital insulin protocol (CHIP) on glycemic control and outcome in critically ill trauma patients.


METHODS
Two, 6-month cohorts were compared, one 6 months prior to chip implementation (pre-CHIP) and one from the 6-month period after implementation (post-CHIP), using finger stick blood glucose values and demographic, injury severity, and outcome variables for adult patients with intensive care unit length of stay (LOS) > or =72 hours. Infectious morbidity was based upon the National Trauma Registry of the American College of Surgeons definitions. Differences between cohorts were assessed using Student's t test and Fisher's exact test for continuous and categorical variables.


RESULTS
The 129 pre- and 128 post-CHIP patients were well matched for demographics and injury severity. Significant reductions in mean finger stick blood glucose, rates of ventilator- associated pneumonia, central venous line infection, total infections, and all LOS categories were demonstrated in the post-CHIP cohort. However, mortality was significantly higher in the post-CHIP cohort.


CONCLUSIONS
This preliminary study demonstrates significant morbidity and LOS reductions with the use of a CHIP, but significantly increased mortality. Further prospective studies are necessary to assess the effects of intensive glycemic control on outcome after injury, particularly in sub populations who might be adversely affected.
Toschlog
Eric A
EA
Department of Surgery, The Brody School of Medicine, East Carolina University, Greenville, North Carolina 27834, USA. etoschlo@pcmh.com
Newton
Christopher
C
Allen
Nichole
N
Newell
Mark A
MA
Goettler
Claudia E
CE
Schenarts
Paul J
PJ
Bard
Michael R
MR
Sagraves
Scott G
SG
Rotondo
Michael F
MF
D000328:Adult; D016638:Critical Illness; D004360:Drug Therapy, Computer-Assisted; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D014947:Wounds and Injuries / Q000150:complications / Q000453:epidemiology* / Q000401:mortality
D007004:Hypoglycemic Agents; D007328:Insulin