Feasibility, efficacy, and safety of a simple insulin infusion protocol in a large volume cardiac surgery unit in India (original) (raw)
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Journal of the ASEAN Federation of Endocrine Societies, 2014
Objectives. The general objective was to compare the efficacy and safety of the Markovitz insulin protocol (MIP) with physician directed insulin infusion (PDI). Specific objectives were to compare the rate of change to normal glucose levels between MIP and PDP, time to achieve normal glucose levels and to determine the number of hypoglycemic episodes between MIP and PDI. Methodology. This is a retrospective study examining the medical records of critically ill patients admitted from 2001-2009. Efficacy outcome was measured as the time to achieve normal glucose level and the mean difference of percentage change towards normal blood glucose level. Safety outcome was measured in terms of frequency of hypoglycemic episodes. Results. One hundred and one patients met the inclusion criteria. The mean time required to achieve target blood glucose levels was 24 hrs (SD=19.5) for MIP compared to PDI. The mean drop in blood glucose levels was-235.49 (SD=113.4), with mean percent difference of-57.5% (SD=20.72) (p-value = 0.919) for MIP compared to physician directed. The MIP resulted in a higher percentage of blood glucose within target (19.57% vs 9.86 %) compared to PID (p= 0.005). Patients in MIP had shorter ICU stay (p=0.049). In addition, MIP was associated with a significantly lower rate of hypoglycemia at 4.2%, compared to PID at 30% (p<0.001). Conclusions. Markovitz insulin protocol appeared to be significant to physician directed insulin infusion in terms of its greater percentage of glucose measurements maintained within target range, without an increased risk of severe hypoglycemia.
Implementation of a Safe and Effective Insulin Infusion Protocol in a Medical Intensive Care Unit
2004
OBJECTIVE -In a recent randomized controlled trial, lowering blood glucose levels to 80 -110 mg/dl improved clinical outcomes in critically ill patients. In that study, the insulin infusion protocol (IIP) used to normalize blood glucose levels provided valuable guidelines for adjusting insulin therapy. In our hands, however, ongoing expert supervision was required to effectively manage the insulin infusions. This work describes our early experience with a safe, effective, nurse-implemented IIP that provides detailed insulin dosing instructions and requires minimal physician input.
Journal of Diabetes Science and Technology, 2008
(BG) blood glucose, (CF) correction factor [insulin sensitivity factor], (CIR) carbohydrate-to-insulin ratio, (CVS) cardiovascular surgery, (DM) diabetes mellitus, (ICU) intensive care unit, (IHI) Institute for Healthcare Improvement, (IV) intravenous, (POD) postoperative day, (RAI) rapid-acting insulin, (SC) subcutaneous insulin, (TDD) total daily dose of insulin
Evaluation of Effectiveness and Safety of an ICU Insulin Infusion Protocol
Journal of the ASEAN Federation of Endocrine Societies, 2014
Objective. To evaluate the efficacy, safety, and clinical outcomes of, and protocol deviations with the use of the Modified Yale Insulin Infusion Protocol (IIP) compared to usual/standard care in the local setting. Methods. Chart review of patients admitted in two ICUs over a 2-year period was done. Patients eligible for intensive glycemic control were identified. Efficacy, safety and clinical outcomes were compared between the Modified Yale IIP and usual/standard care. Charts managed with the IIP were appraised for protocol deviations. Results. Eighty-one patients met the inclusion criteria and 34.6% used the IIP. The IIP group achieved a lower mean blood glucose (185.1 vs 212.1 mg/dl, p<0.05). They reached normoglycemia (5 vs 12 hours, p<0.05) and target range of 140-180 mg/dl (8.3 vs 18.3 hours, p<0.05) earlier. Hypoglycemia was rare (median 0%) in both groups. No difference in mortality or morbidity was seen. Hospital (13.9 vs 8.1 days, p<0.05) and ICU stay (5.5 vs 3.0 days, p<0.05) were longer in the IIP group. A mean of 11 deviations per patient occurred, the majority of which were errors on insulin dose administered (66.6%). Conclusion. The Modified Yale IIP is efficaceous, safe and yielded better glycemic profiles than usual care. Majority of protocol deviations were on the insulin dose administered.
Critical Care Nurse, 2011
Background Recent evidence has linked tight glucose control to worsened clinical outcomes among adults in intensive care units. Objective To 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. Methods A 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. Results Ninety-six patients were enrolled and treated with the protocol. The protocol and control groups had similar characteristics at baseline. More measurements i...
Annals of Intensive Care, 2016
Background: Achieving good glycemic control in intensive care units (ICU) requires a safe and efficient insulin infusion protocol (IIP). We aimed to compare the clinical performance of two IIPs (Leuven versus modified Yale protocol) in patients admitted to medical ICU, by using continuous glucose monitoring (CGM). This is a pooled data analysis of two published prospective randomized controlled trials. CGM monitoring was performed in 57 MICU patients (age 64 ± 12 years, APACHE-II score 28 ± 7, non-diabetic/diabetic: 36/21). The main outcome measures were percentage of time in normoglycemia (80-110 mg/dl) and in hypoglycemia (<60 mg/dl), and glycemic variability (standard deviation, coefficient of variation, mean amplitude of glucose excursions, mean of daily differences). Results: Twenty-two subjects were treated using the Leuven protocol and 35 by the Yale protocol; >63,000 CGM measurements were available. The percentage of time in normoglycemia (80-110 mg/dl) was higher (37 ± 15 vs. 26 ± 11%, p = 0.001) and percentage of time spent in hypoglycemia was lower (0[0-2] vs. 5[1-8]%, p = 0.001) in the Yale group. Median glycemia did not differ between groups (118[108-128] vs. 128[106-154] mg/dl). Glycemic variability was less pronounced in the Yale group (median SD 28[21-37] vs. 47[31-71] mg/dl, p = 0.001; CV 23[19-31] vs. 36[26-50]%, p = 0.001; MODD 35[26-41] vs. 60[33-94] mg/dl, p = 0.001). However, logistic regression could not identify type of IIP, diabetes status, age, BMI, or APACHE-II score as independent parameters for strict glucose control. Conclusions: The Yale protocol provided better average glycemia, more time spent in normoglycemia, less time in hypoglycemia, and less glycemic variability than the Leuven protocol, but was not independently associated with strict glycemic control.