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Intensive Care Medicine

, Volume 33, Issue 4, pp 570–571 | Cite as

Steps for the implementation and validationof tight glucose control

  • Jean-Charles PreiserEmail author
  • Philippe Devos
Editorial

In this issue of Intensive Care Medicine, Meynaar et al. [1] report a very typical stepwise approach required to implement a tight glucose control in their intensive care unit (ICU). Although their starting point (no point-of-care glucose measurement, glucose check once a day in stable patients, no insulin protocol) might seem obsolete for many other ICUs, they actually describe what all of us should do to comply with current recommendations [2]. Whichever the desired target for blood glucose level, it is mandatory to implement a systematic algorithm which will indicate not only the rate of insulin, but also the time for the next glucose check. The use of a dynamic scale rather than a sliding scale appears safer [3]. Of course, such an algorithm must be user-friendly in order to be used and applied when any change of the intake of carbohydrate and/or insulin infusion rate is anticipated. For instance, the adaptation of the insulin infusion rate must be planned when enteral nutrition...

References

  1. 1.
    Meynaar IA, Dawson L, Tangkau PL, Salm EF, Rijks L (2006) Introduction and evaluation of a computerised insulin protocol. Intensive Care Med  DOI 10.1007/s00134-006-0484-z
  2. 2.
    Dellinger RP, Carlet JM, Masur H, Gerlach H, Calandra T, Cohen J, Gea-Banacloche J, Keh D, Marshall JC, Parker MM, Ramsay G, Zimmerman JL, Vincent JL, Levy MM (2004) Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Crit Care Med 32:858–873PubMedCrossRefGoogle Scholar
  3. 3.
    Meijering S, Corstjens AM, Tulleken JE, Meertens JH, Zijlstra JG, Ligtenberg JJ (2006) Towards a feasible algorithm for tight glycaemic control in critically ill patients: a systematic review of the literature. Crit Care 10:R19PubMedCrossRefGoogle Scholar
  4. 4.
    Holzinger U, Kitzberger R, Fuhrmann V, Schenk P, Kramer L, Funk G, Zauner C, Madl C (2006) ICU-staff education and implementation of an insulin therapy algorithm improve blood glucose control. Intensive Care Med 31:S202Google Scholar
  5. 5.
    Lonergan T, Compte AL, Willacy M, Chase JG, Shaw GM, Hann CE, Lotz T, Lin J, Wong XW (2006) A pilot study of the SPRINT protocol for tight glycemic control in critically ill patients. Diabetes Technol Ther 8:449–462PubMedCrossRefGoogle Scholar
  6. 6.
    Rood E, Bosman RJ, Van der Spoel JI, Taylor P, Zandstra DF (2005) Use of computerized guideline for glucose regulation in the intensive care unit improved both guideline adherence and glucose regulation. J Am Med Inform Assoc 12:172–180PubMedCrossRefGoogle Scholar
  7. 7.
    Vogelzang M, Zijlstra F, Nijsten MW (2005) Design and implementation of GRIP: a computerized glucose control system at a surgical intensive care unit. BMC Med Inform Decis Mak 5:38PubMedCrossRefGoogle Scholar
  8. 8.
    Zimmerman CR, Mlynarek ME, Jordan JA, Rajda CA, Horst HM (2004) An insulin infusion protocol in critically ill cardiothoracic surgery patients. Ann Pharmacother 38:1123–1129PubMedCrossRefGoogle Scholar
  9. 9.
    Goldberg PA, Siegel MD, Sherwin RS, Halickman JI, Lee M, Bailey VA, Lee SL, Dziura JD, Inzucchi SE (2004) Implementation of a safe and effective insulin infusion protocol. Diabetes Care 27:461–467PubMedCrossRefGoogle Scholar
  10. 10.
    Kanji S, Singh A, Tierney M, Meggison H, McIntyre L, Hebert PC (2004) Standardization of intravenous insulin therapy improves the efficiency and safety of blood glucose control in critically ill adults. Intensive Care Med 30:804–810PubMedCrossRefGoogle Scholar
  11. 11.
    Vogelzang M, Van der Horst IC, Nijsten MW (2004) Hyperglycaemic index as a tool to assess glucose control: a retrospective study. Crit Care 8:R122–R127PubMedCrossRefGoogle Scholar
  12. 12.
    Van den Berghe G (2004) How to compare adequacy of algorithms to control blood glucose in the intensive care unit? Crit Care 8:151–152PubMedCrossRefGoogle Scholar
  13. 13.
    Egi M, Bellomo R, Stachowski E, French CJ, Hart G (2006) Variability of blood glucose concentration ans short-term mortality in critically ill patients. Anesthesiology 105:244–252PubMedCrossRefGoogle Scholar
  14. 14.
    Preiser JC, Devos P, van den Berghe G (2002) Tight control of glycaemia in critically ill patients. Curr Opin Clin Nutr Metab Care 5:533–537PubMedCrossRefGoogle Scholar
  15. 15.
    Devos P, Preiser JC (2004) Tight blood glucose control: a recommendation applicable to any critically ill patient? Crit Care 8:427–429PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  1. 1.Department of General Intensive Care, University Hospital CentreUniversity of LiegeLiegeBelgium

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