Effect of intravenous insulin therapy on clinical outcomes in critically ill patients.
BACKGROUND
Hyperglycemia commonly occurs in critically ill patients, even in the absence of diabetes mellitus, and is associated with increased morbidity and mortality rates in such patients.


METHODS
Medline search using the terms intravenous insulin, intensive care, myocardial infarction, cardiac surgery and stroke.


CONCLUSIONS
Intravenous insulin therapy with or without adjunctive subcutaneous insulin therapy has been shown to improve morbidity and reduce mortality rates in surgical intensive care populations compared with subcutaneous insulin alone or oral hypoglycemic therapy. The evidence for such is less compelling in medical intensive care populations. Intravenous insulin therapy alone or in combination with glucose and potassium infusion appears to improve clinical outcomes in cardiac surgery patients, but there is conflicting evidence concerning its effect on morbidity and mortality rates after myocardial infarction. Insufficient evidence exists to determine the effect of intravenous insulin therapy on outcomes in other populations including stroke patients, those undergoing major noncardiac surgery, and burn patients. Intravenous insulin nomograms and nurse-driven protocols may improve blood glucose control, resulting in improved clinical outcomes.
Hafidh
Saad A
SA
Department of Medicine, St. John's Mercy Medical Center, St. Louis, Missouri 63141, USA.
Reuter
Matthew D
MD
Chassels
Loren J
LJ
Aradhyula
Sangita
S
Bhutto
Saqib S
SS
Alpert
Martin A
MA
D001786:Blood Glucose / Q000378:metabolism; D006348:Cardiac Surgical Procedures; D002985:Clinical Protocols; D016638:Critical Illness / Q000628:therapy*; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy*; D007275:Injections, Intravenous; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use; D016239:MEDLINE; D009203:Myocardial Infarction / Q000188:drug therapy / Q000503:physiopathology; D016032:Randomized Controlled Trials as Topic; D012196:Review Literature as Topic; D016896:Treatment Outcome
D001786:Blood Glucose; D007328:Insulin