Improvement of Glucose Control in The Intensive Care Unit (An Interdisciplinary Collaboration Study)

ABSTRACT

By Ulrike Holzinger, MD, Monika Feldbacher, RN, Adelbert Bachlechner, RN, Reinhard Kitzberger, MD, Valentin Fuhrmann, MD, and Christian Madl, MD

Background Strict glycemic control in critically ill patients is challenging for both physicians and nurses.

Objectives To determine the effect of focused education of intensive care staff followed by implementation of a glucose control protocol.

Methods A prospective observational study in a medical intensive care unit in a university hospital. After intensive education of nurses and physicians, a glucose control protocol with a nurse-managed insulin therapy algorithm was developed and implemented. Every measured blood glucose value and insulin dose per hour and per day were documented in 36 patients before and 44 patients after implementation of

the protocol.

Results Median blood glucose levels decreased after implementation of the protocol (133 vs 110 mg/dL; P < .001). The amounts of time when patients’ blood glucose levels were less than 110 mg/dL and less than 150 mg/dL increased after implementation of the protocol (8% vs 44%; 75% vs 96%; P<.001). The median use of insulin increased after implementation of the protocol (28 vs 35 IU/day; P=.002). Diabetic patients had higher median blood glucose levels than did nondiabetic patients both before (138 vs 131 mg/dL) and after (115 vs 108 mg/dL; P<.001) implementation, although median insulin use also increased (before implementation, 33 vs 26 IU/day; P=.04; after implementation, 46 vs 30 IU/day; P < .001).

Conclusions Use of a collaboratively developed glucose control protocol led to decreased median blood glucose levels and to longer periods of normoglycemia. Despite increased insulin use, glucose control was worse in diabetic patients.

(American Journal of Critical Care. 2008;17:150-158)

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