Efficacy of Nurses Led Insulin Protocol to Control Blood Glucose among Critically Ill Patients

Background: Amidst the coronavirus disease 2019 (COVID-19) pandemic, continuous glucose monitoring (CGM) has emerged as an alternative for inpatient point-of-care blood glucose (POC-BG) monitoring. We performed a feasibility pilot study using CGM in critically ill patients with COVID-19 in the intensive care unit (ICU). Methods: Single-center, retrospective study of glucose monitoring in critically ill patients with COVID-19 on insulin therapy using Medtronic Guardian Connect and Dexcom G6 CGM systems. Primary outcomes were feasibility and accuracy for trending POC-BG. Secondary outcomes included reliability and nurse acceptance. Sensor glucose (SG) was used for trends between POC-BG with nursing guidance to reduce POC-BG frequency from one to two hours to four hours when the SG was in the target range. Mean absolute relative difference (MARD), Clarke error grids analysis (EGA), and Bland-Altman (B&A) plots were calculated for accuracy of paired SG and POC-BG measurements. Results: CGM devices were placed on 11 patients: Medtronic ( n = 6) and Dexcom G6 ( n = 5). Both systems were feasible and reliable with good nurse acceptance. To determine accuracy, 437 paired SG and POC-BG readings were analyzed. For Medtronic, the MARD was 13.1% with 100% of readings in zones A and B on Clarke EGA. For Dexcom, MARD was 11.1% with 98% of readings in zones A and B. B&A plots had a mean bias of −17.76 mg/dL (Medtronic) and −1.94 mg/dL (Dexcom), with wide 95% limits of agreement. Conclusions: During the COVID-19 pandemic, CGM is feasible in critically ill patients and has acceptable accuracy to identify trends and guide intermittent blood glucose monitoring with insulin therapy.

Download Full-text

Saline versus 5% dextrose in water as a drug diluent for critically ill patients: a retrospective cohort study

Journal of Intensive Care ◽

10.1186/s40560-020-00489-6 ◽

2020 ◽

Vol 8 (1) ◽

Author(s):

Yukari Aoyagi ◽

Takuo Yoshida ◽

Shigehiko Uchino ◽

Masanori Takinami ◽

Shoichi Uezono

Keyword(s):

Blood Glucose ◽

Critically Ill ◽

Critically Ill Patients ◽

Glucose Control ◽

Blood Glucose Control ◽

Kidney Injury ◽

Saline Group ◽

Significant Difference ◽

The Impact ◽

Electrolyte Abnormalities

Abstract Background The choice of intravenous infusion products for critically ill patients has been studied extensively because it can affect prognosis. However, there has been little research on drug diluents in this context. The purpose of this study is to evaluate the impact of diluent choice (saline or 5% dextrose in water [D5W]) on electrolyte abnormalities, blood glucose control, incidence of acute kidney injury (AKI), and mortality. Methods This before-after, two-group comparative, retrospective study enrolled adult patients who stayed for more than 48 h in a general intensive care unit from July 2015 to December 2018. We changed the default diluent for intermittent drug sets in our electronic ordering system from D5W to saline at the end of 2016. Results We included 844 patients: 365 in the D5W period and 479 in the saline period. Drug diluents accounted for 21.4% of the total infusion volume. The incidences of hypernatremia and hyperchloremia were significantly greater in the saline group compared to the D5W group (hypernatremia 27.3% vs. 14.6%, p < 0.001; hyperchloremia 36.9 % vs. 20.4%, p < 0.001). Multivariate analyses confirmed the similar effects (hypernatremia adjusted odds ratio (OR), 2.43; 95% confidence interval (CI), 1.54–3.82; hyperchloremia adjusted OR, 2.09; 95% CI, 1.31–3.34). There was no significant difference in the incidences of hyperglycemia, AKI, and mortality between the two groups. Conclusions Changing the diluent default from D5W to saline had no effect on blood glucose control and increased the incidences of hypernatremia and hyperchloremia.

Download Full-text

Blood glucose monitoring in critically ill patients

British Journal of Neuroscience Nursing ◽

10.12968/bjnn.2010.6.7.79229 ◽

2010 ◽

Vol 6 (7) ◽

pp. 342-344 ◽

Cited By ~ 1

Author(s):

Sarah Hassall ◽

Carole Butler- Williams

Keyword(s):

Blood Glucose ◽

Critically Ill ◽

Critically Ill Patients ◽

Glucose Monitoring ◽

Blood Glucose Monitoring

Download Full-text

Glycaemic control in critical illness

10.1093/med/9780199600830.003.0259 ◽

2016 ◽

Author(s):

Simon Finfer

Keyword(s):

Blood Glucose ◽

Critically Ill ◽

Critically Ill Patients ◽

Blood Glucose Concentration ◽

Point Of Care ◽

Glucose Variability ◽

Severe Illness ◽

Loop Control ◽

Considerable Uncertainty ◽

Glucose Management

Hyperglycaemia is a near universal occurrence in critically-ill patients. In the last 10 years, control of blood glucose has been one of the most intensively studied areas of critical care medicine. It has become clear that control of blood glucose has the potential to affect both morbidity and mortality, and considerable uncertainty remains over many aspects of blood glucose management. Both hyperglycaemia and hypoglycaemia are associated with increased mortality and should be avoided wherever possible. Wide fluctuations in blood glucose concentration (referred to as increased glucose variability) are also associated with increased mortality, but may indicate more severe illness. Increased interest in blood glucose management has demonstrated that point-of-care glucose meters designed for ambulatory use by patient with diabetes are not sufficiently accurate for use in critically-ill patients. More accurate analysers should be used in the intensive care unit and management guided by computerized. Future developments may see the introduction of accurate continuous or near continuous blood glucose analysers, but safe and effective closed loop control of blood glucose remains an elusive goal.

Download Full-text