Implementation of a safe and effective insulin administration protocol in a medical-surgical ICU

AIM Analysis of the research group’s experience of the continuous IV insulin infusion protocol (Leuven’s protocol) for obtaining and maintaining normoglycemia in ICU patients. Retrospective comparison with the previous method of managing hyperglycemia in the same ICU is also elaborated. MATERIAL-METHOD The research took place in a four-bed ICU, treating both medical and surgical patients. Blood sugar measurements of two groups were compared. The first group (Group A) included 25 patients, all subjected to the Leuven protocol. A similar number of patients treated just before the Leuven protocol adoption was retrospectively compared. The later group (Group B) included 27 patients whose hyperglycemia cases during their stay in ICU were treated per needed with a combination of subcutaneous and bolus intravenous insulin administration. Fisher’s Exact test, t-test, Mann-Whitney test and 2-Way Annova test were used to check both groups’ consistency. All statistical evaluation was performed using SPSS 12.0. RESULTS In Group A, 3404 BS measurements were performed and the mean value was 117±37 mg/dL (median 112), while in Group B 1818 BG measurements were obtained with a mean value of 144±48 mg/dL (median 136). There was statistically significant impact of the group regarding the percentage of measurements in the range of normoglycemia (80-110 mg/dL) for each patient (P=0.024)-group Α 41.6±11.4% (median=40%) and group Β 20.6±18.9% (median=16.7%). Hypoglycemia (BS<40 mg/dL) was observed in one patient of group A at a rate of 0.5% of his total measurements and in 2 patients of group B (1% and 0.3% correspondingly). CONCLUSION The research group’s experience of the Leuven protocol has indicated that the later is an effective and safe guideline for the maintenance of normoglycemia. Furthermore, this study established the protocol’s superiority compared to the previous method of hyperglycemia management in the same ICU.

Category: Volume 47, N 2
Hits: 714 Hits
Created Date: 15-06-2008
Authors: Athanasios Mastrokostas , Maria Gkrizioti , Vassilios Vassiliou