Intensive insulin therapy is associated with reduced infectious complications in burn patients.
BACKGROUND
Intensive insulin therapy to control blood glucose levels has reduced mortality in surgical, but not medical, intensive care unit (ICU) patients. Control of blood glucose levels has also been shown to reduce morbidity in surgical ICU patients. There is very little data for use of intensive insulin therapy in the burn patient population. We sought to evaluate our experience with intensive insulin therapy in burn-injured ICU patients with regard to mortality, morbidity, and use of hospital resources.


METHODS
Burn patients admitted to our American College of Surgeons verified burn center ICU from 7/1/2004 to 6/30/2006 were studied. An intensive insulin therapy protocol was initiated for ICU patients admitted starting 7/1/2005 with a blood glucose target of 100-140 mg/dL. The 2 groups of patients studied were control (7/1/2004 to 6/30/2005) and intensive insulin therapy (7/1/2005 to 6/30/2006). All glucose values for the hospitalization were analyzed. Univariate and multivariate analyses were performed.


RESULTS
Overall, 152 ICU patients admitted with burn injury were available for study. No difference in mortality was evident between the control and intensive insulin therapy groups. After adjusting for patient risk, the intensive insulin therapy group was found to have a decreased rate of pneumonia, ventilator-associated pneumonia, and urinary tract infection. In patients with a maximum glucose value of greater than 140 mg/dL, the risk for an infection was significantly increased (OR 11.3, 95% CI 4-32, P-value < .001). The presence of a maximum glucose value greater than 140 mg/dL was associated with a sensitivity of 91% and specificity of 62% for an infectious complication.


CONCLUSIONS
Intensive insulin therapy for burn-injured patients admitted to the ICU was associated with a reduced incidence of pneumonia, ventilator-associated pneumonia, and urinary tract infection. Intensive insulin therapy did not result in a change in mortality or length of stay when adjusting for confounding variables. Measurement of a blood glucose level greater than 140 mg/dL should heighten the clinical suspicion for the presence of an infection in patients with burn injury.
Hemmila
Mark R
MR
Department of Surgery, University of Michigan Medical Center, Ann Arbor, MI 48109-5033, USA. mhemmila@umich.edu
Taddonio
Michael A
MA
Arbabi
Saman
S
Maggio
Paul M
PM
Wahl
Wendy L
WL
D000328:Adult; D000704:Analysis of Variance; D001786:Blood Glucose / Q000032:analysis*; D002053:Burn Units; D002056:Burns / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality* / Q000628:therapy; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D015994:Incidence; D007262:Infusions, Intravenous; D015601:Injury Severity Score; D007328:Insulin / Q000008:administration & dosage*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011336:Probability; D011379:Prognosis; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome; D014946:Wound Infection / Q000453:epidemiology / Q000517:prevention & control*
D001786:Blood Glucose; D007328:Insulin