Neurocritical Care

, Volume 12, Issue 1, pp 43–49

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

  • Salmaan Kanji
  • Erika Jones
  • Rob Goddard
  • Hilary E. Meggison
  • David Neilipovitz
Original Article

DOI: 10.1007/s12028-009-9275-z

Cite this article as:
Kanji, S., Jones, E., Goddard, R. et al. Neurocrit Care (2010) 12: 43. doi:10.1007/s12028-009-9275-z

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.

Keywords

InsulinIntensive care unitsHypoglycemiaNervous system diseasesBlood glucoseNeurotraumaNeurovascular injury

Copyright information

© Humana Press Inc. 2009

Authors and Affiliations

  • Salmaan Kanji
    • 1
    • 2
    • 3
  • Erika Jones
    • 1
  • Rob Goddard
    • 1
  • Hilary E. Meggison
    • 4
  • David Neilipovitz
    • 5
  1. 1.Department of PharmacyThe Ottawa HospitalOttawaCanada
  2. 2.Department of Critical CareThe Ottawa HospitalOttawaCanada
  3. 3.Department of Clinical EpidemiologyThe Ottawa Health Research InstituteOttawaCanada
  4. 4.Departments of Endocrinology and Metabolism, and Critical CareThe Ottawa HospitalOttawaCanada
  5. 5.Departments of Critical Care and AnesthesiologyThe Ottawa HospitalOttawaCanada