title: Moderate glycemic control safe in critically ill adult burn patients: A 15 year cohort study.
abstract: BACKGROUND
  Hyperglycemia is a metabolic alteration in major burn patients associated with complications. The study aimed at evaluating the safety of general ICU glucose control protocols applied in major burns receiving prolonged ICU treatment.
  
  
  METHODS
  15 year retrospective analysis of consecutive, adult burn patients admitted to a single specialized centre.
  
  
  METHODS
  death or length of stay <10 days, age <16 years.
  
  
  METHODS
  demographic variables, burned surface (TBSA), severity scores, infections, ICU stay, outcome. Metabolic variables: total energy, carbohydrate and insulin delivery/24h, arterial blood glucose and CRP values. Analysis of 4 periods: 1, before protocol; 2, tight doctor driven; 3, tight nurse driven; 4, moderate nurse driven.
  
  
  RESULTS
  229 patients, aged 45 ± 20 years (mean ± SD), burned 32 ± 20% TBSA were analyzed. SAPSII was 35 ± 13. TBSA, Ryan and ABSI remained stable. Inhalation injury increased. A total of 28,690 blood glucose samples were analyzed: the median value remained unchanged with a narrower distribution over time. After the protocol initiation, the normoglycemic values increased from 34.7% to 65.9%, with a reduction of hypoglycaemic events (no extreme hypoglycemia in period 4). Severe hyperglycemia persisted throughout with a decrease in period 4 (9.25% in period 4). Energy and glucose deliveries decreased in periods 3 and 4 (p<0.0001). Infectious complications increased during the last 2 periods (p=0.01).
  
  
  CONCLUSIONS
  A standardized ICU glucose control protocol improved the glycemic control in adult burn patients, reducing glucose variability. Moderate glycemic control in burns was safe specifically related to hypoglycemia, reducing the incidence of hypoglycaemic events compared to the period before. Hyperglycemia persisted at a lower level.
authors.affiliation: Service of Intensive Care Medicine & Burns, University Hospital (CHUV), 1011 Lausanne, Switzerland. Electronic address: Patricia.Stoecklin@chuv.ch.
authors.forename: Patricia
authors.initials: P
authors.lastname: Stoecklin
authors.affiliation: Service of Intensive Care Medicine & Burns, University Hospital (CHUV), 1011 Lausanne, Switzerland. Electronic address: fdelodder@gmail.com.
authors.forename: Frederik
authors.initials: F
authors.lastname: Delodder
authors.affiliation: Service of Intensive Care Medicine & Burns, University Hospital (CHUV), 1011 Lausanne, Switzerland. Electronic address: Pantet@chuv.ch.
authors.forename: Olivier
authors.initials: O
authors.lastname: Pantet
authors.affiliation: Service of Intensive Care Medicine & Burns, University Hospital (CHUV), 1011 Lausanne, Switzerland. Electronic address: Mette.Berger@chuv.ch.
authors.forename: Mette M
authors.initials: MM
authors.lastname: Berger
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D002056:Burns / Q000150:complications / Q000378:metabolism / Q000628:therapy*; D002985:Clinical Protocols; D015331:Cohort Studies; D003422:Critical Care; D064648:Critical Care Nursing; D016638:Critical Illness / Q000628:therapy*; D019468:Disease Management; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism; D007003:Hypoglycemia / Q000139:chemically induced; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010347:Patient Care Planning; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: Complication; Critical illness; Hypoglycemia; Insulin utilisation; Nutrition