Reduction in hypoglycemic events in critically ill patients on continuous insulin following implementation of a treatment guideline.
BACKGROUND
Hyperglycemia is common in critically ill children and appears to be associated with poor outcomes. However, the incidence of hypoglycemia while attempting glycemic control using an insulin infusion may be as high as 25% and hypoglycemia may be an independent risk factor for mortality in critically ill children.


METHODS
An improvement team developed a guideline for initiation and maintenance of insulin infusions for hyperglycemia in critically ill, nondiabetic patients in the pediatric intensive care unit. The guideline included an insulin infusion algorithm that provided an initiating dose, titration instructions, and discontinuation parameters. Guideline recommendations addressed the frequency of bedside blood glucose monitoring and management of symptomatic hypoglycemia while on insulin infusion. The guideline was implemented in late January 2007 and revised in September 2007.


RESULTS
Hypoglycemic events in at-risk patients decreased significantly following implementation of the guideline, from 36% to 3%, despite an increase in the total number of patient days on insulin infusion. The average days between hypoglycemic events increased from 21 to 186.


CONCLUSIONS
Implementation of a guideline to manage critical illness hyperglycemia in nondiabetic, critically ill pediatric patients resulted in a reduction in hypoglycemic events and a sustained increase in the days between such events.
Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA. ranjit.chima@cchmc.org
Ranjit S
RS
Chima
Pamela J
PJ
Schoettker
Kartik R
KR
Varadarajan
Elizabeth
E
Kloppenborg
Tamara K
TK
Hutson
Richard J
RJ
Brilli
David R
DR
Repaske
Michael
M
Seid
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007003:Hypoglycemia / Q000188:drug therapy* / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D015278:Intensive Care Units, Pediatric / Q000458:organization & administration*; D007902:Length of Stay; D008297:Male; D017410:Practice Guidelines as Topic
D007328:Insulin