Computer-assisted glucose control in critically ill patients.
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.
Vogelzang
Mathijs
M
Department of Critical Care, University Medical Center, University of Groningen, 9700 RB, Groningen, The Netherlands. m.vogelzang@thorax.umcg.nl
Loef
Bert G
BG
Regtien
Joost G
JG
van der Horst
Iwan C C
IC
van Assen
Hein
H
Zijlstra
Felix
F
Nijsten
Maarten W N
MW
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
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin