Glycemic control has multiple potential benefits including decreased infection, shorter length of stay, decreased mortality and lower cost of care.1
Phase 1 (2 months) involved an intensive education program for our nurses, residents and students about the importance of glycemic control for ICU patients. Relevant articles were distributed and information disseminated. Other than education, no specific protocol for glycemic control was applied during Phase 1.In Phase 2 (2 months), patients predicted to spend >48 hours in our intensive care unit were started a protocol using computerized physician order entry (CPOE) calling for insulin titration to keep blood sugar between 80 and 110mg/dl. Blood glucose was checked every six hours. Compliance was measured as a percentage of determinations per day that patients met goal, i.e. 1 of 4 would be 25% of the time vs. 4 of 4 would be 100% of the time.
A sliding scale treatment regimen was used during Phase 1. Initially, 14% of patients achieved glycemic control on 4 out of 4 measurements, dropping to 12.5% during the second month of Phase 1. During Phase 2, up to 38% of patients achieved 100% glycemic control. 7.5% of patients required D50 bolus for glucose ≤ 60.
A continuous insulin infusion protocol is significantly more effective in achieving glycemic control in the intensive care unit than a sliding scale protocol. Glycemic control within this narrow range is difficult to achieve 100% of the time even with a strict protocol using an insulin infusion. CPOE facilitates implementation of a safety protocol for glycemic control.CLINICAL IMPLICATION: Compliance with recommended protocols involving glycemic control in the ICU can be enhanced through CPOE and insulin infusion.
W.T. McGee, None.