For light glycemic control in the intensive care unit (ICU), recent studies attribute a lack of benefit and potential harm primarily to a higher frequency of hypoglycemia. Two caloric variations, caloric interruptions and caloric boluses (such as meals), commonly account for hypoglycemic episodes in patients on certain insulin infusion protocols. Rapid downward titration in insulin doses has been reported as essential in preventing hypoglycemia. To reduce the adverse outcome of hypoglycemia, we focused on utilizing the strategy of rapid downward titration, and coupling it with mechanisms to assist the frontline nurse in averting hypoglycemia associated with caloric variations.
The ICU nursing staff was presented with data on dysglycemia for the 14‐bed ICU in our community leaching hospital and then voted to change the insulin infusion protocol from a multiplier‐based version to a oolumn (table) version based on the Braithwaite protocol. Originally developed to achieve safe but tight glycemic control in the ICU setting, the Braithwaite model was chosen because of its prominent downward titration of insulin when blood glucose levels normalize. Our modifications to the Braithwaite protocol included provisions for dextrose during caloric interruptions and supplemental insulin for caloric boluses. Following nursing education, the protocol was launched as a nurse‐driven intervention.
Three hundred and forty‐eight patient‐days qualified for this study. After 109 patient‐days of baseline data, 246 posBntervenlion patient days were assessed. The percentage of patient‐day mean glucose (PDMG) values < 140 mg/dLand the percentage of all qualifying serum glucose values < 70 mg/dL were calculated on a monthly basis. After implementation of the column infusion, the percentage of patient days with PDMG values < 140 mg/dL increased from 43% to 64% (P < 0.05). Hypoglycemia decreased from 5.4% to 2.4% (P < 0.05).
When modified to address variation in caloric intake, a nurse‐driven insulin infusion protocol already designed to trigger rapid titration of insulin has the capacity to reduce hypoglycemia in the ICU significantly while maintaining or improving overall glycemic control. Further research should examine if the effectiveness of such protocols can be confirmed in larger populations across multiple centers.
H. Shabbir, none; J. Stein, Emory University, entitled to royalties tinder patent‐licensing arrangement through Emory University; A. Wang, none; D. Tong, none.
To cite this abstract:Shabbir H, Stein J, Wang A, Tong D. Reducing Hypoglycemia in the Intensive Care Unit. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 129. https://www.shmabstracts.com/abstract/reducing-hypoglycemia-in-the-intensive-care-unit/. Accessed December 10, 2018.