A Literature Review of Intensive Insulin Therapy and Mortality in Critically Ill Patients

Chen, Lifen

doi:10.1097/nur.0b013e3181cf55af

Cited by 15 publications

(5 citation statements)

References 30 publications

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“…Chen 14 in a literature review of intensive insulin therapy in critical illness, found no studies comparing the safety and effectiveness of different published IIPs. Although similarities existed between protocols, goals for blood glucose level varied.…”

Section: Knowledge Deficit Regarding Glycemic Controlmentioning

confidence: 99%

Glycemic Control in Cardiac Surgery: Implementing an Evidence-Based Insulin Infusion Protocol

Hargraves

2014

American Journal of Critical Care

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Background Acute hyperglycemia following cardiac surgery increases the risk of deep sternal wound infection, significant early morbidity, and mortality. Insulin infusion protocols that target tight glycemic control to treat hyperglycemia have been linked to hypoglycemia and increased mortality. Recently published studies examining glycemic control in critical illness and clinical practice guidelines from professional organizations support moderate glycemic control. Objectives To measure critical care nurses' knowledge of glycemic control in cardiac surgery before and after education. To evaluate the safety and effectiveness of an evidence-based insulin infusion protocol targeting moderate glycemic control in cardiac surgery patients. Methods This evidence-based practice change was implemented in the cardiovascular unit in a community teaching hospital. Nurses completed a self-developed questionnaire to measure knowledge of glycemic control. Blood glucose data, collected (retrospectively) from anesthesia end time through 11:59 PM on postoperative day 2, were compared from 2 months before to 2 months after the practice change. Results Nurses' knowledge (test scores) increased significantly after education (pretest mean = 53.10, SD = 11.75; posttest mean = 79.10, SD = 12.02; t 54 = -8.18, P < .001). Mean blood glucose level after implementation was 148 mg/dL. The incidence of hypoglycemia, 2.09% before and 0.22% after the intervention, was significantly reduced ( 2 1 [n = 29] = 13.9, P < .001). The percentage of blood glucose levels less than 180 mg/dL was 88.30%. Conclusions Increasing nurses' knowledge of glycemic control and implementing an insulin infusion protocol targeting moderate glycemic control were effective for treating acute hyperglycemia following cardiac surgery with decreased incidence of hypoglycemia.

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Section: Knowledge Deficit Regarding Glycemic Controlmentioning

confidence: 99%

Glycemic Control in Cardiac Surgery: Implementing an Evidence-Based Insulin Infusion Protocol

Hargraves

2014

American Journal of Critical Care

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“…Patients were categorized as having diabetes based on these prescription data if they were on any of the medications used for diabetes and did not meet the following exclusion criteria: (1) patients on metformin alone with a discharge diagnostic code for polycystic ovarian syndrome or (2) patients who received short‐ or rapid‐acting insulin alone. The latter exclusion criterion was chosen on the basis that some patients have been noted to receive insulin infusions for optimal blood glucose control in acute illness (intensive care units) despite recent contrary evidence of benefit , or may have received these treatments for correction of hyperkalaemia (see also Supporting Information, Figure S1, for categorization based on medication). We compared the demographic characteristics, co‐morbidities (Charlson score ) and length of stay of patients who had a discharge diagnostic code for diabetes and those who did not have but were identified through their prescribed medication.…”

Section: Methodsmentioning

confidence: 99%

Inpatient electronic prescribing data can be used to identify ‘lost’ discharge codes for diabetes

et al. 2012

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“…Tight glycemic control without increased risk of hypoglycemia has proven difficult to achieve in intensive care in both adults [61] and neonates [62]. Moderately elevated blood glucose levels are recently more tolerated or recommended [63] because of the fear of hypoglycemia and higher nursing effort frequently associated with TGC [64].…”

Section: Discussionmentioning

confidence: 99%

Modeling the glucose regulatory system in extreme preterm infants

Compte¹,

Chase²,

Russell³

et al. 2011

Computer Methods and Programs in Biomedicine

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BACKGROUNDPremature infants represent a significant proportion of the neonatal intensive care population. Blood glucose homeostasis in this group is often disturbed by immaturity of endogenous regulatory systems and the stress of their condition. Hypo-and hyperglycemia are frequently reported in very low birth weight infants, and more mature infants often experience low levels of glycemia. A model capturing the unique fundamental dynamics of the neonatal glucose regulatory system could be used to develop better blood glucose control methods.

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A Literature Review of Intensive Insulin Therapy and Mortality in Critically Ill Patients

Cited by 15 publications

References 30 publications

Glycemic Control in Cardiac Surgery: Implementing an Evidence-Based Insulin Infusion Protocol

Glycemic Control in Cardiac Surgery: Implementing an Evidence-Based Insulin Infusion Protocol

Inpatient electronic prescribing data can be used to identify ‘lost’ discharge codes for diabetes

Modeling the glucose regulatory system in extreme preterm infants

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