Intensive Insulin Protocol Improves Glucose Control and Is Associated with a Reduction in Intensive Care Unit Mortality

Charles C. Reed, Ronald M Stewart, Michele Sherman, John G Myers, Michael G. Corneille, Nanette Larson, Susan Gerhardt, Randall Beadle, Conrado Gamboa, Daniel L Dent, Stephen M. Cohn, Basil A Pruitt

Research output: Contribution to journalArticle

77 Citations (Scopus)

Abstract

Background: Intensive insulin therapy to maintain serum glucose levels between 80 and 110 mg/dL has previously been shown to reduce mortality in the critically ill; recent data, however, have called this benefit into question. In addition, maintaining uniform, tight glucose control is challenging and resource demanding. We hypothesized that, by use of a protocol, tight glucose control could be achieved in the surgical trauma intensive care unit (STICU), and that improved glucose control would be beneficial. Study Design: During the study period, a progressively more rigorous approach to glucose control was used, culminating in an implemented protocol in 2005. We reviewed STICU patients' blood glucose levels, measured by point-of-care testing, from 2003 to 2006. Mortality was tracked over the course of the study, and patient charts were retrospectively reviewed to measure illness and injury severity. Results: Mean blood glucose levels steadily improved (p < 0.01). In addition to absolute improvements in glucose control, total variability of glucose ranges in the STICU steadily diminished. A reduction in STICU mortality was temporally associated with implementation of the protocol (p < 0.01). There were fewer intraabdominal abscesses and fewer postinjury ventilator days after implementation of the protocol. There was a small increase in the incidence of clinically relevant hypoglycemia. Conclusions: Improvements in glucose control in the ICU can be achieved by using a protocol for intensive insulin therapy. In our ICU, this was temporally associated with a significant reduction in mortality.

Original languageEnglish (US)
Pages (from-to)1048-1054
Number of pages7
JournalJournal of the American College of Surgeons
Volume204
Issue number5
DOIs
StatePublished - May 2007

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Intensive Care Units
Insulin
Glucose
Mortality
Critical Care
Wounds and Injuries
Blood Glucose
Mechanical Ventilators
Hypoglycemia
Critical Illness
Abscess
Incidence
Therapeutics
Serum

ASJC Scopus subject areas

  • Surgery

Cite this

Intensive Insulin Protocol Improves Glucose Control and Is Associated with a Reduction in Intensive Care Unit Mortality. / Reed, Charles C.; Stewart, Ronald M; Sherman, Michele; Myers, John G; Corneille, Michael G.; Larson, Nanette; Gerhardt, Susan; Beadle, Randall; Gamboa, Conrado; Dent, Daniel L; Cohn, Stephen M.; Pruitt, Basil A.

In: Journal of the American College of Surgeons, Vol. 204, No. 5, 05.2007, p. 1048-1054.

Research output: Contribution to journalArticle

Reed, CC, Stewart, RM, Sherman, M, Myers, JG, Corneille, MG, Larson, N, Gerhardt, S, Beadle, R, Gamboa, C, Dent, DL, Cohn, SM & Pruitt, BA 2007, 'Intensive Insulin Protocol Improves Glucose Control and Is Associated with a Reduction in Intensive Care Unit Mortality', Journal of the American College of Surgeons, vol. 204, no. 5, pp. 1048-1054. https://doi.org/10.1016/j.jamcollsurg.2006.12.047
Reed, Charles C. ; Stewart, Ronald M ; Sherman, Michele ; Myers, John G ; Corneille, Michael G. ; Larson, Nanette ; Gerhardt, Susan ; Beadle, Randall ; Gamboa, Conrado ; Dent, Daniel L ; Cohn, Stephen M. ; Pruitt, Basil A. / Intensive Insulin Protocol Improves Glucose Control and Is Associated with a Reduction in Intensive Care Unit Mortality. In: Journal of the American College of Surgeons. 2007 ; Vol. 204, No. 5. pp. 1048-1054.
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