title: The impact of intensive insulin protocols and restrictive blood transfusion strategies on glucose measurement in American Burn Association (ABA) verified burn centers.
abstract: The prevalence of intensive insulin and restrictive blood use protocols in burn centers is unknown, which may be problematic as the combined impact of these therapies is to concomitantly increase the prevalence of anemia and hypoglycemia in intensive care unit patients. Such a development is important because point-of-care (POC) glucometers report erroneously high values in the presence of low hematocrit (HCT), potentially masking the presence of hypoglycemia. We hypothesized that most American Burn Association (ABA) verified burn centers have adopted intensive insulin therapy while simultaneously restricting blood transfusions potentially increasing risk of hypoglycemia. All ABA verified burn centers (N = 44) were contacted. Clinical practices regarding intensive insulin therapy, restrictive transfusion practices, and the use of POC glucometers were evaluated. Intensive insulin protocols were implemented at 73% of ABA centers (defined as upper glucose target of < or = 120 mg/dl) and POC glucometers measurement was nearly universal; 95% of ABA centers use them routinely. Anemia is prevalent in intensive care units and may be increasing because of recent changes in practice. Defined hemoglobin and HCT levels trigger blood transfusion at 84% of centers, and of these, 51% restrict transfusion to hemoglobin < 7 g/dl or HCT < 22%. Most ABA centers now use intensive insulin protocols, many in combination with restrictive transfusion strategies. The combination of a higher prevalence of hypoglycemia in the presence of near universal anemia is concerning, particularly given the pervasiveness of glucometer use among burn centers.
authors.affiliation: United States Army Institute of Surgical Research, Brooke Army Medical Center, San Antonio, TX, USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Mann
authors.forename: Heather F
authors.initials: HF
authors.lastname: Pidcoke
authors.forename: Jose
authors.initials: J
authors.lastname: Salinas
authors.forename: John B
authors.initials: JB
authors.lastname: Holcomb
authors.forename: Steven E
authors.initials: SE
authors.lastname: Wolf
authors.forename: Charles E
authors.initials: CE
authors.lastname: Wade
mesh_terms: D000740:Anemia / Q000517:prevention & control*; D001786:Blood Glucose / Q000378:metabolism*; D001803:Blood Transfusion / Q000379:methods*; D002053:Burn Units / Q000592:standards; D002056:Burns / Q000150:complications / Q000503:physiopathology*; D019538:Health Care Surveys; D006801:Humans; D007003:Hypoglycemia / Q000517:prevention & control*; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use; D015995:Prevalence; D012307:Risk Factors; D012955:Societies, Medical; D014481:United States
chemical_list: D001786:Blood Glucose; D007328:Insulin