title: Performance assessment of a glucose control protocol in septic patients with an automated intermittent plasma glucose monitoring device.
abstract: OBJECTIVE
  The optimal level and modality of glucose control in critically ill patients is still debated. A protocolized approach and the use of nearly-continuous technologies are recommended to manage hyperglycemia, hypoglycemia and glycemic variability. We recently proposed a pato-physiology-based glucose control protocol which takes into account patient glucose/carbohydrate intake and insulin resistance. Aim of the present investigation was to assess the performance of our protocol with an automated intermittent plasma glucose monitoring device (OptiScanner™ 5000).
  
  
  METHODS
  OptiScanner™ was used in 6 septic patients, providing glucose measurement every 15' from a side-port of an indwelling central venous catheter. Target level of glucose was 80-150 mg/dL. Insulin infusion and kcal with nutritional support were also recorded.
  
  
  RESULTS
  6 septic patients were studied for 319 h (1277 measurements); 58 [45-65] hours for each patient (measurements/patient: 231 [172-265]). Blood glucose was at target for 93 [90-98]% of study time. Mean plasma glucose was 126 ± 11 mg/dL. Only 3 hypoglycemic episodes (78, 78, 69 mg/dL) were recorded. Glucose variability was limited: plasma glucose coefficient of variation was 11.7 ± 4.0% and plasma glucose standard deviation was 14.3 ± 5.5 mg/dL.
  
  
  CONCLUSIONS
  The local glucose control protocol achieved satisfactory glucose control in septic patients along with a high degree of safeness. Automated intermittent plasma glucose monitoring seemed useful to assess the performance of the protocol.
authors.affiliation: Unità Operativa di Anestesia e Rianimazione, Azienda Ospedaliera San Paolo - Polo Universitario, Italy. Electronic address: michele.umbrello@ao-sanpaolo.it.
authors.forename: M
authors.initials: M
authors.lastname: Umbrello
authors.affiliation: Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Salice
authors.affiliation: Unità Operativa di Anestesia e Rianimazione, Azienda Ospedaliera San Paolo - Polo Universitario, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Spanu
authors.affiliation: Unità Operativa di Anestesia e Rianimazione, Azienda Ospedaliera San Paolo - Polo Universitario, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Formenti
authors.affiliation: Dipartimento di Scienze della Salute, Università degli Studi di Milano, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Barassi
authors.affiliation: Dipartimento di Scienze della Salute, Università degli Studi di Milano, Italy.
authors.forename: G V
authors.initials: GV
authors.lastname: Melzi d'Eril
authors.affiliation: Unità Operativa di Anestesia e Rianimazione, Azienda Ospedaliera San Paolo - Polo Universitario, Italy; Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Iapichino
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D015190:Blood Glucose Self-Monitoring / Q000295:instrumentation* / Q000379:methods; D015992:Body Mass Index; D016638:Critical Illness; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000188:drug therapy; D007003:Hypoglycemia / Q000097:blood / Q000188:drug therapy; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D007328:Insulin / Q000008:administration & dosage; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D018805:Sepsis / Q000097:blood*
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: Automated glucose control; Blood glucose; Critically ill patients; Glucose control protocol; Sepsis