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.
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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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DOI: https://doi.org/10.1007/s12028-009-9275-z