Haemodialysis, nutritional disorders and hypoglycaemia in critical care

Abstract

This study aimed to determine hypoglycemia incidence and associated factors in critically ill patients. It looked at a retrospective cohort with 106 critically ill adult patients with 48 hours of glycaemic control and 72 hours of follow up. The dependent variable, hypoglycaemia (≤70 mg/dl), was assessed with respect to independent variables: age, diet, insulin, catecholamines, haemodialysis, nursing workload and the Simplified Acute Physiology Score. Statistical analysis was performed using Student's t-test, Fisher's exact test and logistic regression at 5% significance level. Incidence of hypoglycaemia was 14.2%. Hypoglycaemia was higher in the group of patients on catecholamines (p=0.040), with higher glycaemic variability (p<0.001) and death in the intensive care unit (p=0.008). Risk factors were identified as absence of oral diet (OR 5.11; 95% CI 1.04-25.10) and haemodialysis (OR 4.28; 95% CI 1.16-15.76). Patients on haemodialysis and with no oral diet should have their glycaemic control intensified in order to prevent and/or manage hypoglycaemic episodes.

Cross mapping between clinical indicators for assistance in intensive care and nursing interventions

“…Mechanical ventilatory assistance (2, [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] . 17…”

“…Infusion of vasoactive drug (2,25,27,43) , altered blood pressure (2,21,(32)(33) , increased gastric residual volume (20,27,35,40) . 4…”

“…Endotracheal suction (24,28,32) , mental confusion (29,36,38) , incontinence dermatitis (25,37,41) , dyspnoea (4,18,30) , hypertension (4,31,39) , hyperthermia (17,25,38) , hypotension (2,31,39) , hypothermia (17,25,38) , hemodynamic instability (4,26,43) , skin injury (4,41,44) , obesity (38,41,46) , nasal probe / oroenteral (24,26,44) , bladder catheter (24,26,41) , vomiting (27,35,38) .…”

“…Respiratory acidosis (21) , administration of laxative drugs (37) , administration of insulin (27) , distress (30) , alertness (29) , altered breathing pattern (38) , hallucinations (36) , antibiotic therapy (26) , anuria (2) , apathy (30) , apnea (39) , apprehension (19) , asynchrony with ventilator (33) , aid in feeding (30) , aid in walking (30) , underweight (46) , tiredness (33) , coma (38) , mechanical restraint (26) , compressive dressing in arterial puncture (4) , depression (4) , discomfort (30) , disorientation (14) , communication difficulties (41) , dysphonia (28) , dysrhythmia (18) , abdominal distension (35) , abdominal pain (35) , health education (45) , spirituality (45) , erythema (41) , exhaustion (14) , extubation (44) , fatigue (33) , liquid stools (37) , hemodialysis (27) , oral hygiene (32) , hyperalbuminemia (25) , hypercapnia (21) , hypercreatinemia (38) , hypernatremia (17) , hyperuremia (38) , hypocapnia (38) , hyponatremia (17) , hypoperfusion…”

“…Change in sleep pattern (14,30) , analgesia (18,24) , arrhythmia (26,39) , bed bath (25,32) , calm (30,33) , constipation (20,35) , convulsion (16,38) , malnutrition (37)(38) , desaturation (38)(39) , dysphagia (28,40) , edema (4,35) , altered respiratory rate (2,38) , body hygiene (30,32) , hyperglycemia (38,47) , hypoalbuminemia (25)(26) , hypoglycemia (27,47) , hypoxia (2,26) , insomnia (4,33) , respiratory failure (16)(17) , pressure injury (44,46) , fear (30,33) , restricted mobilization (17,26) , change of position (2,32) , nausea (4,38) , parenteral nutrition (26)(27)…”