Glucose management in critically ill medical and surgical patients.
Currently, many providers treat hyperglycemia in the critically ill based on guidelines suggesting target glucose ranges between 140 and 180 mg/dL. However, recent literature has attempted to challenge this by comparing the effect of intensive insulin therapy (IIT) to conventional insulin therapy. Four studies examining the impact of IIT and conventional insulin therapy on mortality in critically ill patients were examined and analyzed. The outcomes from these studies are mixed with neither therapy showing marked improvement in morbidity and mortality rates; in fact, these studies showed a trend toward increased mortality related to an increased incidence of hypoglycemia with IIT. Factors such as days of mechanical ventilation, infection rates, length of stay in the ICU, and incidence of organ failure were included as secondary end points. The data suggest IIT may improve patient outcomes in some areas, but the data are not statistically significant, and adoption of an IIT protocol is not recommended at this time.
Lauren Schiffner, MSN, CRNP, AGACNP-BC, CCRN, is a surgical/trauma critical care nurse at the Hospital of the University of Pennsylvania and a recently graduated adult gerontology acute care nurse practitioner from the University of Pennsylvania School of Nursing.
Lauren
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Schiffner
D001786:Blood Glucose / Q000032:analysis*; D064648:Critical Care Nursing; D016638:Critical Illness / Q000401:mortality / Q000451:nursing*; D006801:Humans; D006943:Hyperglycemia / Q000150:complications / Q000401:mortality / Q000451:nursing*; D007003:Hypoglycemia / Q000150:complications / Q000401:mortality / Q000451:nursing*; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D012307:Risk Factors
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin