PURPOSE: Maintenance of normoglycemia in critically ill patients is believed to achieve better outcomes. Hypoglycemia remains a serious potential complication. Monitoring and titration of blood glucose are required to achieve target blood glucose levels while avoiding a dangerously low blood glucose. We report the results of a time survey comparing titration of insulin infusion to titration of vasopressor infusions in medical critically ill patients.
METHODS: Patients admitted to the MICU in 2005 who required both vasopressor infusion to control blood pressure and insulin infusion to control blood glucose were studied. The vasopressor infusion was titrated to maintain a mean arterial pressure between 60–80 mmHg and the insulin infusion was titrated to maintain blood glucose between 100–140 mg%. The total time in minutes required to measure the variables and institute therapy was measured. Time studies were done on all shifts (night, day, weekends).
RESULTS: 143 patients were studied. The mean age was 79 (± 12). The average time required to implement the insulin protocol was 5.1 minutes per hour. The average time of vasopressor titration in patients with an indwelling arterial catheter was 3.6 minutes per hour as compared to 4.2 minutes per hour in patients without an arterial catheter (P=0.04). The time necessary for blood glucose determination was higher than the time of vasopressor titration (P=0.01). There were no time differences between shifts for either insulin or vasopressor titration.
CONCLUSION: It is more time consuming to monitor and deliver an insulin infusion than infusing vasopressors. Further research is needed to simplify insulin infusion protocols and to rapidly obtain blood glucose measurements.
CLINICAL IMPLICATIONS: Intensive glucose management is extremely time-consuming.
DISCLOSURE: Yatin Mehta, No Product/Research Disclosure Information; No Financial Disclosure Information