Published in:
Open Access 01-08-2008 | Original
Computer-assisted glucose control in critically ill patients
Published in: Intensive Care Medicine | Issue 8/2008
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Objective
Intensive insulin therapy is associated with the risk of hypoglycemia and increased costs of material and personnel. We therefore evaluated the safety and efficiency of a computer-assisted glucose control protocol in a large population of critically ill patients.
Design and setting
Observational cohort study in three intensive care units (32 beds) in a 1,300-bed university teaching hospital.
Patients
All 2,800 patients admitted to the surgical, neurosurgical, and cardiothoracic units; the study period started at each ICU after implementation of Glucose Regulation for Intensive Care Patients (GRIP), a freely available computer-assisted glucose control protocol.
Measurements and results
We analysed compliance in relation to recommended insulin pump rates and glucose measurement frequency. Patients were on GRIP-ordered pump rates 97% of time. Median measurement time was 5 min late (IQR 20 min early to 34 min late). Hypoglycemia was uncommon (7% of patients for mild hypoglycemia, < 3.5 mmol/l; 0.86% for severe hypoglycemia, < 2.2 mmol/l). Our predefined target range (4.0–7.5 mmol/l) was reached after a median of 5.6 h (IQR 0.2–11.8) and maintained for 89% (70–100%) of the remaining stay at the ICU. The number of measurements needed was 5.9 (4.8–7.3) per patient per day. In-hospital mortality was 10.1%.
Conclusions
Our computer-assisted glucose control protocol provides safe and efficient glucose regulation in routine intensive care practice. A low rate of hypoglycemic episodes was achieved with a considerably lower number of glucose measurements than used in most other schemes.