Glucose control in Mayo Clinic intensive care units.
BACKGROUND
Safe and effective glucose control in the intensive care unit (ICU) continues to be actively pursued. Large clinical trials have examined the safety and efficacy of insulin infusion protocols in medical and surgical ICUs. We report experiences of a single-center standardized nurse-driven insulin infusion protocol in three ICUs in an observational quality-improvement study.


METHODS
We analyzed the hourly point-of-care arterial blood glucose obtained during ICU insulin infusion protocol (protocol A) with a glucose target of 80-130 mg/dl in medical and surgical ICUs in February 2009. Following Normoglycemia in Intensive Care Evaluation and Survival Using Glucose Algorithm Regulation (NICE-SUGAR) study results, the protocol was amended (protocol B) to achieve target glucose of 110-150 mg/dl. The performance of protocol B was assessed in the ICUs in May 2010 and compared with protocol A with respect to glucose concentrations and rates of severe (<40 mg/dl) and moderate (40-60 mg/dl) hypoglycemia.


RESULTS
With protocol A, in medical (n = 44) and surgical (n = 164) ICUs taken together, median glucose was 119 mg/dl, with severe and moderate hypoglycemia rates 1.4% (3/208) and 7.7% (16/208), respectively, which were significantly lower than those reported by the NICE-SUGAR and the Leuven studies. With protocol B, in medical (n = 44) and surgical (n = 167) ICUs taken together, median glucose was 132 mg/dl, with severe and moderate hypoglycemia of 0 % (0/211) and 0.5% (1/211), respectively.


CONCLUSIONS
The current ICU insulin infusion protocol (protocol B) reduces severe and moderate hypoglycemia without compromising glucose control when compared with protocol A. This could potentially impact patient-important outcomes.
Division of Endocrinology and Metabolism, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
Vishwanath
V
Pattan
Ajay
A
Parsaik
Julie K
JK
Brown
Yogish C
YC
Kudva
Nicholas
N
Vlahakis
Ananda
A
Basu
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000451:nursing / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin