title: Computer-assisted glucose control in critically ill patients.
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.
  
  
  METHODS
  Observational cohort study in three intensive care units (32 beds) in a 1,300-bed university teaching hospital.
  
  
  METHODS
  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.
  
  
  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.
authors.affiliation: Department of Critical Care, University Medical Center, University of Groningen, 9700 RB, Groningen, The Netherlands. m.vogelzang@thorax.umcg.nl
authors.forename: Mathijs
authors.initials: M
authors.lastname: Vogelzang
authors.forename: Bert G
authors.initials: BG
authors.lastname: Loef
authors.forename: Joost G
authors.initials: JG
authors.lastname: Regtien
authors.forename: Iwan C C
authors.initials: IC
authors.lastname: van der Horst
authors.forename: Hein
authors.initials: H
authors.lastname: van Assen
authors.forename: Felix
authors.initials: F
authors.lastname: Zijlstra
authors.forename: Maarten W N
authors.initials: MW
authors.lastname: Nijsten
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000187:drug effects*; D003422:Critical Care / Q000379:methods*; D004360:Drug Therapy, Computer-Assisted; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D007332:Insulin Infusion Systems; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin