Steps for the implementation and validationof tight glucose control
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In this issue of Intensive Care Medicine, Meynaar et al.  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 . 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 . 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...
- 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.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
- 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