Intensive Insulin Protocol Improves Glucose Control and Is Associated with a Reduction in Intensive Care Unit Mortality - 19/08/11

Doi : 10.1016/j.jamcollsurg.2006.12.047

Charles C. Reed, BSN , Ronald M. Stewart, MD, FACS ^†,^⁎, Michele Sherman, BSN , John G. Myers, MD, FACS ^†, Michael G. Corneille, MD, FACS , Nanette Larson, BSN , Susan Gerhardt, MSN , Randall Beadle, BSN , Conrado Gamboa, MS, RPH , Daniel Dent, MD, FACS ^†, Stephen M. Cohn, MD, FACS ^†, Basil A. Pruitt, MD, FACS ^†
Surgical Trauma Intensive Care Unit, University Health System, San Antonio, TX
^† Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX.

Correspondence address: Ronald M Stewart, MD, Department of Surgery, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229.

Résumé

Background

Intensive insulin therapy to maintain serum glucose levels between 80 and 110 mg/dL has previously been shown to reduce mortality in the critically ill; recent data, however, have called this benefit into question. In addition, maintaining uniform, tight glucose control is challenging and resource demanding. We hypothesized that, by use of a protocol, tight glucose control could be achieved in the surgical trauma intensive care unit (STICU), and that improved glucose control would be beneficial.

Study Design

During the study period, a progressively more rigorous approach to glucose control was used, culminating in an implemented protocol in 2005. We reviewed STICU patients’ blood glucose levels, measured by point-of-care testing, from 2003 to 2006. Mortality was tracked over the course of the study, and patient charts were retrospectively reviewed to measure illness and injury severity.

Results

Mean blood glucose levels steadily improved (p < 0.01). In addition to absolute improvements in glucose control, total variability of glucose ranges in the STICU steadily diminished. A reduction in STICU mortality was temporally associated with implementation of the protocol (p < 0.01). There were fewer intraabdominal abscesses and fewer postinjury ventilator days after implementation of the protocol. There was a small increase in the incidence of clinically relevant hypoglycemia.

Conclusions

Improvements in glucose control in the ICU can be achieved by using a protocol for intensive insulin therapy. In our ICU, this was temporally associated with a significant reduction in mortality.

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