Efficiency and Safety of a Standardized Protocol for Intravenous Insulin Therapy in ICU Patients with Neurovascular or Head Injury (original) (raw)

Abstract

Background

To evaluate the safety and efficiency of a protocol for glycemic control in intensive care unit (ICU) patients with neurovascular or head injury.

Methods

Two cohorts of 50 consecutive patients admitted to the ICU with an admission diagnosis of neurovascular or head injury before and after protocol implementation were evaluated. All patients in the interventional cohort received insulin using a standardized intravenous insulin infusion protocol targeting blood glucose levels of 7–9 mmol/l. Efficiency (time to reach and time within target range), safety (hypoglycemia), and nursing compliance (protocol violations) were evaluated.

Results

The median time to reach the target blood glucose range was shorter in the interventional cohort than the conventional cohort (5.0 h [0.5–20.5 h] vs. 12.9 h [1.3–90.3 h]; P < 0.001). More time was spent within target range in the interventional cohort than in the conventional cohort (36.4 ± 16.3% vs. 27.1 ± 19.0%; P < 0.001). The median prevalence of mild (<4.9 mmol/l) hypoglycemia (0 [0–1.11]% vs. 0.58 [0–2.79]%; P < 0.001) and moderate (<3.9) hypoglycemia (0[0–0.55]% vs. 0 [1–1.25]%; p < 0.001) was significantly lower in the interventional cohort.

Conclusions

The intravenous insulin infusion protocol improved the safety and efficiency of glycemic control for ICU patients with neurovascular or head injury.

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Acknowledgments

ICU nurses, physicians, pharmacists and staff at The Ottawa Hospital; The Ottawa Hospital Pharmacy Research Committee; Nikki O’Brien, The Ottawa Hospital Institute for Patient Safety.

Financial Support

This study was funded by the Centre for Patient Safety, The Ottawa Hospital.

Author information

Authors and Affiliations

  1. Department of Pharmacy, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
    Salmaan Kanji, Erika Jones & Rob Goddard
  2. Department of Critical Care, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
    Salmaan Kanji
  3. Department of Clinical Epidemiology, The Ottawa Health Research Institute, Ottawa, Canada
    Salmaan Kanji
  4. Departments of Endocrinology and Metabolism, and Critical Care, The Ottawa Hospital, Ottawa, Canada
    Hilary E. Meggison
  5. Departments of Critical Care and Anesthesiology, The Ottawa Hospital, Ottawa, Canada
    David Neilipovitz

Authors

  1. Salmaan Kanji
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  2. Erika Jones
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  3. Rob Goddard
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  4. Hilary E. Meggison
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  5. David Neilipovitz
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Corresponding author

Correspondence toSalmaan Kanji.

Appendix I

Appendix I

Insulin Infusion Protocol for Patients with Neurovascular or Head Injury

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Kanji, S., Jones, E., Goddard, R. et al. Efficiency and Safety of a Standardized Protocol for Intravenous Insulin Therapy in ICU Patients with Neurovascular or Head Injury.Neurocrit Care 12, 43–49 (2010). https://doi.org/10.1007/s12028-009-9275-z

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