Glycemic control of hospitalized patients is associated with improved outcomes. However, in post-ICU respiratory care unit (RCU) patients there are no treatment guidelines on managing hyperglycemia. We report the results of a 2-yr process improvement project in that setting.
The 14 bed Mt. Sinai Hospital RCU for post-ICU care and weaning of ventilator dependent patients has Nurse Practitioners as primary care providers. In 2001, changes were instituted to control blood glucoses under the supervision of a single endocrinologist: increased awareness of hyperglycemia, stepwise reduction in target glucose levels to 80-110 mg%, changing insulin from NPH BID to Lente Q8H, avoidance of oral hypoglycemic agents, expeditious titration of enteral feeding rates and more aggressive treatment of glucose toxicity. Blood glucoses and insulin dosing for all RCU patients during the first quarter of 2001 (Group I) were compared to those during the last quarter of 2002 (Group II).
Demographics and hospital survival between Group I (N=39, 535 glucose measurements) and Group II (N=20, 646 glucose measurements) were not significantly different. RCU admission glucoses were identical in both groups (140 ± 51 vs. 140 ± 72, p=.99). However, over the course of the RCU stay, patients in Group II had statistically lower glucoses (Graph 1) achieved by titration to statistically higher doses of Lente (Graph 2). Six percent of glucoses in Group I were less than 80 mg%, compared to 20% of measurements in Group II (p<.01), with no clinically significant episodes of hypoglycemia.CONCLUSIONS: In the RCU, blood glucoses of 80-110 mg% can be achieved using a titration schedule of Lente and Regular Insulin. The tradeoff is an increased number of non-clinically significant glucoses below this range.
Using these data as a baseline, protocols can now be developed to standardize control of blood glucoses in ventilator dependent patients in the post-ICU setting
D.M. Nierman, None.