BackgroundCritically ill patients with diabetes mellitus (DM) are at increased risk of in-hospital complications and the optimal glycemic target for such patients remains unclear. A more liberal approach to glucose control has recently been suggested for patients with DM, but uncertainty remains regarding its impact on complications. MethodsWe aimed to test the hypothesis that complications would be more common with a liberal glycemic target in ICU patients with DM. Thus, we compared hospital-acquired complications in the first 400 critically ill patients with DM included in a sequential before-and-after trial of liberal (glucose target: 10-14 mmol/l) versus conventional (glucose target: 6-10 mmol/l) glucose control. ResultsOf the 400 patients studied, 165 (82.5%) patients in the liberal and 177 (88.5%) in the conventionalcontrol group were coded for at least one hospital-acquired complication (p=0.09). When comparing clinically relevant complications diagnosed between ICU admission and hospital discharge, we found no difference in the odds for infectious (adjusted odds ratio [aOR] for liberal-control: 1.15 [95% CI: 0.68-1.96], p=0.60), cardiovascular (aOR 1.40 [95% CI: 0.63-3.12], p=0.41) or neurological complications (aOR: 1.07 [95% CI: 0.61-1.86], p=0.81), acute kidney injury (aOR 0.83 [95% CI: 0.43-1.58], p=0.56) or hospital mortality (aOR: 1.09 [95% CI: 0.59-2.02], p=0.77) between the liberal and the conventional-control group. ConclusionIn this prospective before-and-after study, liberal glucose control was not associated with an increased risk of hospital-acquired infectious, cardiovascular, renal or neurological complications in critically ill patients with diabetes.

No abstract

The aim of this study was to determine whether assessing patient risk of developing pressure injuries in Pediatric Intensive Care (PICU) and Neonatal Units (NNU) using a modification of the Glamorgan Scale (mGS) would alter the risk identification when compared to the Glamorgan Scale (GS). Prospective data were collected from a convenience sample of patients admitted to PICU or NNU during a 2-month period. The patients' pressure injury risk score using both instruments was collected by observing patients, reviewing patient records, and clarifying information with bedside nurses. Chi square analysis was used to compare the risk category allocations. A total of 133 patients were assessed with complete data available for 112 (PICU = 68, NNU = 65). The total number of admissions during the data collection period was 202 in PICU and 100 in NNU. There was an extensive spread of patients allocated to the "High Risk" and "Very High Risk" categories in both units. Only one was in the lower "At Risk" category. There was little difference in allocated risk category between the mGS and the GS (p = 0.982). Only one patient was not allocated to the same risk category by both tools. In addition to identifying little difference in risk identification the mGS was found to be easier to complete. The mGS delivered the same risk rating as the GS when applied to patients in the PICU and NNU. It is not clear if a similar agreement exists in the general pediatric population. When modifying a validated tool for local use consideration should be given as to how those modifications might alter outcomes.

No abstract