Blood Glucose Measurements in Arterial Blood of Intensive Care Unit Patients Submitted to Tight Glycemic Control: Agreement between Bedside Tests

Background The efficiency of protocols for tight glycemic control is uncertain despite their adoption in hospitals. Objectives To evaluate the efficiency of protocols for tight glycemic control used in intensive care units. Methods Three separate studies were performed: (1) a third-party observer used a stopwatch to do a time-motion analysis of patients being treated with a protocol for tight glycemic control in 3 intensive care units, (2) charts were retrospectively reviewed to determine the frequency of deviations from the protocol, and (3) a survey assessing satisfaction with and knowledge of the protocol was administered to full-time nurses. Results Time-motion data were collected for 454 blood glucose determinations from 38 patients cared for by 47 nurses. Mean elapsed times from blood glucose result to therapeutic action were 2.24 (SD, 1.67) minutes for hypoglycemia and 10.65 (SD, 3.24) minutes for hyperglycemia. Mean elapsed time to initiate an insulin infusion was 32.56 (SD, 12.83) minutes. Chart review revealed 734 deviations from the protocol in 75 patients; 57% (n = 418) were deviations from scheduled times for blood glucose measurements. The mean number of deviations was approximately 9 per patient. Of 60 nurses who responded to the workload survey, 42 (70%) indicated that the protocol increased their workload; frequency of blood glucose determinations was the most common reason. Conclusions Nurses spend substantial time administering protocols for tight glycemic control, and considerable numbers of deviations occur during that process. Further educational efforts and ongoing assessment of the impact of such protocols are needed.

Download Full-text

Evaluation of Implementation of a Fully Automated Algorithm (Enhanced Model Predictive Control) in an Interacting Infusion Pump System for Establishment of Tight Glycemic Control in Medical Intensive Care Unit Patients

Journal of Diabetes Science and Technology ◽

10.1177/193229680800200606 ◽

2008 ◽

Vol 2 (6) ◽

pp. 963-970 ◽

Cited By ~ 16

Author(s):

Roman Kulnik ◽

Johannes Plank ◽

Christoph Pachler ◽

Malgorzata E. Wilinska ◽

Andrea Groselj-Strele ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Glycemic Control ◽

Predictive Control ◽

Medical Intensive Care Unit ◽

Infusion Pump ◽

Tight Glycemic Control ◽

Pump System ◽

Automated Algorithm ◽

Medical Intensive Care

Download Full-text

A minimum blood glucose value less than or equal to 120 mg/dL under glycemic control is associated with increased 14-day mortality in nondiabetic intensive care unit patients with sepsis and stress hyperglycemia

Journal of Critical Care ◽

10.1016/j.jcrc.2016.04.002 ◽

2016 ◽

Vol 34 ◽

pp. 69-73 ◽

Cited By ~ 9

Author(s):

Ming-Cheng Chan ◽

Jeng-Sen Tseng ◽

Kuo-Hsuan Hsu ◽

Sou-Jen Shih ◽

Chi-Yuan Yi ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Blood Glucose ◽

Glycemic Control ◽

Stress Hyperglycemia

Download Full-text

IMPLEMENTATION OF TIGHT GLYCEMIC CONTROL IN THE INTENSIVE CARE UNIT

CHEST Journal ◽

10.1378/chest.130.4_meetingabstracts.148s-b ◽

2006 ◽

Vol 130 (4) ◽

pp. 148S

Author(s):

Russell A. Acevedo ◽

Daniel J. Polacek ◽

David M. Landsberg ◽

Mary E. Greco

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Glycemic Control ◽

Tight Glycemic Control

Download Full-text

Glycemic Control in Neurological Intensive Care Unit Patients

Clinical nutrition and metabolism ◽

10.17816/clinutr60533 ◽

2021 ◽

Vol 1 (4) ◽

pp. 190-196

Author(s):

Kirill Y. Krylov ◽

Ivan A. Savin ◽

Sergey V. Sviridov ◽

Irina V. Vedenina ◽

Marina V. Petrova ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Glycemic Control ◽

Critically Ill ◽

Metabolic Response ◽

Glucose Production ◽

Tight Glycemic Control ◽

Point Of View ◽

Neurological Intensive Care Unit ◽

Neurological Intensive Care

Critically ill patients often develop hyperglycemia because of the metabolic response to trauma and stress. In response to any form of damage to the organism, it reacts by increasing its own glucose production which subsequently causes hyperglycemia. This adaptive reaction of the organism is directed to aid in the rapid restoration after the damage. Therefore, glucose is an indispensable substrate in the critically ill which aids the reparation process. Severe and persistent hyperglycemia is associated with unfavorable outcomes and is considered to be an independent predictor of in-hospital mortality. The discussion remains on whether hyperglycemia is just a marker of increased stress which makes it a surrogate indicator of disease severity or if it is the reason for the unfavorable outcome. A few years ago, several published articles suggested that a tight glycemic control within the normal range improves treatment outcome. Over time, researchers have changed their point of view and currently there is a discussion on this matter in the scientific literatures. At the same time, the question of what glycemic level should be maintained for patients in the Neurological Intensive Care Unit is a matter of discussion. In this review, the authors analyzed the latest guidelines on treatment of critical patients with neurosurgical and neurological pathologies, specifically the glycemic control in this category of patients.

Download Full-text