Nurse-Led Implementation of a Safe and Effective Intravenous Insulin Protocol in a Medical Intensive Care Unit

2011 ◽  
Vol 31 (6) ◽  
pp. 27-35 ◽  
Author(s):  
Rabia Khalaila ◽  
Eugene Libersky ◽  
Dina Catz ◽  
Elina Pomerantsev ◽  
Abed Bayya ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Glucose ◽  
Medical Intensive Care Unit ◽  
Control Group ◽  
Glucose Levels ◽  
Intravenous Insulin ◽  
Blood Glucose Levels ◽  
Protocol Group ◽  
Medical Intensive Care

BackgroundRecent evidence has linked tight glucose control to worsened clinical outcomes among adults in intensive care units.ObjectiveTo evaluate the effectiveness and safety of a nurse-led intravenous insulin protocol designed to achieve conservative blood glucose control in patients in a medical intensive care unit.MethodsA nurse-led intravenous insulin protocol was developed, targeting blood glucose levels at 110 to 149 mg/dL. Hypoglycemia was defined as a blood glucose level less than 70 mg/dL. Patients admitted to the medical intensive care unit who required an insulin infusion were enrolled in the study. Blood glucose levels in those patients were compared with levels in 153 historical control patients admitted to the unit in the 12 months before the protocol was implemented who required an insulin infusion.ResultsNinety-six patients were enrolled and treated with the protocol. The protocol and control groups had similar characteristics at baseline. More measurements in the protocol group than in the control group (46.3% vs 36.1%, P<.001) were within the target glucose range (110–149 mg/dL). Hyperglycemia (blood glucose ≥200 mg/dL) occurred less often in the protocol group than in the control group (14.8% vs 20.1%, P=.003). Hypoglycemic events (blood glucose <70 mg/dL) also occurred less often in the protocol group (0.07% vs 0.83%, P<.001).ConclusionsImplementation of a nurse-led, conservative intravenous insulin protocol in the medical intensive care unit is effective and safe and markedly reduces the rate of hypoglycemia.

Blood glucose amplitude variability as predictor for mortality in surgical and medical intensive care unit patients: a multicenter cohort study

2012 ◽  
Vol 27 (2) ◽  
pp. 119-124 ◽  
Author(s):  
Iwan A. Meynaar ◽  
Saeid Eslami ◽  
Ameen Abu-Hanna ◽  
Peter van der Voort ◽  
Dylan W. de Lange ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cohort Study ◽  
Intensive Care ◽  
Blood Glucose ◽  
Medical Intensive Care Unit ◽  
Multicenter Cohort Study ◽  
Amplitude Variability ◽  
Multicenter Cohort ◽  
Medical Intensive Care

scholarly journals Evaluation of the oxidative profile of critical patients hospitalized in adult intensive care unit

2021 ◽  
Vol 43 ◽  
pp. e13-43351
Author(s):  
Lídia Miranda Brinati ◽  
Carla De Fátima Januário ◽  
Silvia Almeida Cardoso ◽  
Tiago Ricardo Moreira ◽  
Daniel Silva Sena Bastos ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Lipid Peroxidation ◽  
Superoxide Dismutase ◽  
Intensive Care ◽  
Blood Glucose ◽  
Initial Time ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Reducing Ability ◽  
Critical Patients

The objective of this work was to evaluate and correlate the oxidative stress in patients with uncontrolled blood glucose levels (hyperglycemia or hypoglycemia) hospitalized in an intensive care unit (ICU). This was a cross-sectional study, performed with 26 patients in an ICU of a hospital in the Zona da Mata in Minas Gerais. Patients with uncontrolled blood glucose levels were evaluated in two moments: on the day of admission (T0) and one day after the uncontrolled glycaemia (DG1). The evaluation of the oxidative profile was determined by the dosage of serum total antioxidant capacity, based on the ability of ferric reduction, determination of enzymatic activity of Superoxide Dismutase, Catalase and Glutathione S-Transferase, lipid peroxidation products and carbonylated proteins. The levels of ferric reducing ability decreased significantly, whereas the activity of the Superoxide Dismutase enzyme increased significantly after uncontrolled glycaemia in relation to the initial time. Although the lipid peroxidation did not change between the times evaluated, the damage marker significantly reduced, shown by carbonylation of proteins after the uncontrolled glycaemia. The critical patients evaluated in this study present altered oxidative profile after the uncontrolled glycaemia, a common problem that imposes the worst prognoses.

Effects of Different Blood Glucose Levels on Critically Ill Patients in an Intensive Care Unit

2015 ◽  
Vol 25 (6) ◽  
pp. 388-393 ◽  
Author(s):  
Li Kang ◽  
Juan Han ◽  
Qun-Cao Yang ◽  
Hui-Lin Huang ◽  
Nan Hao
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Glucose ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Fasting Blood Glucose ◽  
Apache Ii Score ◽  
High Blood Glucose ◽  
Glucose Levels ◽  
Blood Glucose Levels

<b><i>Aims:</i></b> We explore the infection incidence and possible prognostic outcome relevance for patients with different blood glucose levels in an intensive care unit (ICU). <b><i>Methods:</i></b> A total of 98 cases were enrolled and divided into three groups based on average fasting blood glucose levels (group A: ≤6.1 mmol/l; group B: 6.1-10 mmol/l; group C: ≥10 mmol/l). <b><i>Results:</i></b> There were no statistical differences in the time to ICU admission, the indwelling durations of gastric tubes, urinary or deep vein catheters, tracheal intubations and tracheotomies, or the length of ventilator use (all p > 0.05). No evident difference in the multiple organ dysfunction syndrome rate was found between the three groups (p = 0.226). The infection and mortality rates between the groups showed significant differences (all p < 0.05). Furthermore, the difference of respiratory system infections was statistically significant among the three groups (p = 0.008), yet no such statistical difference was observed among groups regarding nonrespiratory system infections (p = 0.227). <b><i>Conclusions:</i></b> Critically ill patients with a high blood glucose level were positively correlated with a relatively high APACHE II score and more serious degree of disease, as well as a higher incidence of respiratory infection during their ICU stay than those with lower blood glucose levels (<10 mmol/l).

Time dependent decrease in blood glucose levels after sampling potentially affects intensive insulin therapy in the intensive care unit

2008 ◽  
Vol 35 (2) ◽  
pp. 386-387 ◽  
Author(s):  
D. Posthouwer ◽  
M. J. de Graaf ◽  
M. Frederiks ◽  
J. A. Remijn ◽  
J. H. Rommes ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Glucose ◽  
Insulin Therapy ◽  
Intensive Insulin Therapy ◽  
Time Dependent ◽  
Glucose Levels ◽  
Blood Glucose Levels

Improvement of Glucose Control in the Intensive Care Unit: An Interdisciplinary Collaboration Study

2008 ◽  
Vol 17 (2) ◽  
pp. 150-156 ◽  
Author(s):  
Ulrike Holzinger ◽  
Monika Feldbacher ◽  
Adelbert Bachlechner ◽  
Reinhard Kitzberger ◽  
Valentin Fuhrmann ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Glucose ◽  
Glucose Control ◽  
Care Staff ◽  
Diabetic Patients ◽  
Control Protocol ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Insulin Use

Background Strict glycemic control in critically ill patients is challenging for both physicians and nurses. Objectives To determine the effect of focused education of intensive care staff followed by implementation of a glucose control protocol. Methods A prospective observational study in a medical intensive care unit in a university hospital. After intensive education of nurses and physicians, a glucose control protocol with a nurse-managed insulin therapy algorithm was developed and implemented. Every measured blood glucose value and insulin dose per hour and per day were documented in 36 patients before and 44 patients after implementation of the protocol. Results Median blood glucose levels decreased after implementation of the protocol (133 vs 110 mg/dL; P &lt; .001). The amounts of time when patients’ blood glucose levels were less than 110 mg/dL and less than 150 mg/dL increased after implementation of the protocol (8% vs 44%; 75% vs 96%; P&lt;.001). The median use of insulin increased after implementation of the protocol (28 vs 35 IU/day; P=.002). Diabetic patients had higher median blood glucose levels than did nondiabetic patients both before (138 vs 131 mg/dL) and after (115 vs 108 mg/dL; P&lt;.001) implementation, although median insulin use also increased (before implementation, 33 vs 26 IU/day; P=.04; after implementation, 46 vs 30 IU/day; P &lt; .001). Conclusions Use of a collaboratively developed glucose control protocol led to decreased median blood glucose levels and to longer periods of normoglycemia. Despite increased insulin use, glucose control was worse in diabetic patients.

Evaluation of Admission Blood Glucose Levels in the Intensive Care Unit

2007 ◽  
Vol 13 (7) ◽  
pp. 705-710 ◽  
Author(s):  
Lisa Fish ◽  
Amy Moore ◽  
Blaine Morgan ◽  
Robyn Anderson
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Glucose ◽  
Glucose Levels ◽  
Blood Glucose Levels

Insulin Requirements in the Intensive Care Unit in Response to Infection

2008 ◽  
Vol 74 (9) ◽  
pp. 845-848 ◽  
Author(s):  
Nell Maloney ◽  
Rebecca C. Britt ◽  
Gregory D. Rushing ◽  
Scott F. Reed ◽  
Fredric C. Cole ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Glucose ◽  
Elevated Temperature ◽  
Blood Cell ◽  
Cell Count ◽  
Insulin Dose ◽  
Blood Cell Count ◽  
Glucose Levels ◽  
Blood Glucose Levels

Infectious complications in the intensive care unit (ICU) are classically identified when an elevated temperature triggers obtaining cultures. Elevated temperature, however, is a nonspecific marker of infection and may occur well into the course of the infection. The goal of this study was to evaluate whether escalating insulin demands may serve as an earlier marker for infection. A retrospective review of a prospective database from a trauma ICU over a 6-month period was done for all patients who developed infection while in the ICU. All patients in the ICU are placed at admission on an intensive insulin protocol with target blood glucose levels between 80 and 110 mg/dL. Data were collected on infection, insulin needs, blood glucose levels, temperature, white blood cell count, and antibiotic use. Twenty-four infections were identified, with 16 pneumonias, four bloodstream infections, and four urinary tract infections. Twelve of the 24 patients had increasing insulin needs in the 3 days preceding their infection diagnosis, with nine of the 12 requiring continued escalation of insulin needs from preinfection Day 3 to 2 to 1 (D3, D2, D1). In five of the 12 patients, the escalation of insulin dose preceded the elevated temperature, and in three of the 12 patients, the escalation preceded elevation of the white blood cell count above 12. For all 24 patients, the average insulin dose increased steadily, from 1.8 U/hr on D3 preinfection to 2.5 U/hr D2 and 3.1 U/hr D1. Infection does seem to be preceded by escalating insulin demands in many patients. A prospective study to evaluate the value of increased insulin demand as a marker for developing infection is warranted.

Blood Glucose Amplitude Variability as Predictor for Mortality in Surgical and Medical Intensive Care Unit Patients

2013 ◽  
Vol 57 (1) ◽  
pp. 5
Author(s):  
Iwan A. Meynaar ◽  
Saeid Eslami ◽  
Ameen Abu-Hanna ◽  
Peter van der Voort ◽  
Dylan W. de Lange ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Glucose ◽  
Medical Intensive Care Unit ◽  
Amplitude Variability ◽  
Medical Intensive Care
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