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Intensive Glycemic Management in Critically Ill Patients

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Background: The effect of an intensive glycemic management protocol was assessed in a heterogeneous population of critically ill adult patients.

Methods: Patients representing 800 consecutive admissions following the institution of the protocol were compared with the 800 admissions immediately preceding the institution of the protocol in a 14-bed mixed medical-surgical intensive care unit (ICU). The protocol used intensive monitoring and treatment to maintain blood glucose values > 140 mg/dl. Continuous intravenous insulin was used if glucose values were > 200 mg/dl on two successive occasions.

Results: Mean glucose decreased from 152.3 mg/dl to 130.7 mg/dl (p < .001), marked by a 56.3% reduction in the percentage of glucose values ≥ 200 mg/dl, without a significant change in hypoglycemia. There were decreases in the development of new renal insufficiency (p = .034) and in the number of patients receiving transfusion of packed red blood cells (p = .035) during the protocol period. Hospital mortality decreased 29.3% (p = .002), and ICU length of stay decreased 10.8% (p = .011) after institution of the protocol.

Discussion: The 29.3% relative reduction in hospital mortality seen among the treatment patients following institution of the protocol probably exceeded the expectations of the initiative's champions. The culture of the ICU regarding glycemic control changed definitively. The protocol was extended to an intermediate care unit, resulting in improvement in glycemic control without an increase in hypoglycemia.

Document Type: Research Article

Publication date: June 1, 2005

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  • Published monthly, The Joint Commission Journal on Quality and Patient Safety is a peer-reviewed publication dedicated to providing health professionals with the information they need to promote the quality and safety of health care. The Joint Commission Journal on Quality and Patient Safety invites original manuscripts on the development, adaptation, and/or implementation of innovative thinking, strategies, and practices in improving quality and safety in health care. Case studies, program or project reports, reports of new methodologies or new applications of methodologies, research studies on the effectiveness of improvement interventions, and commentaries on issues and practices are all considered.

    David W. Baker, MD, MPH, FACP, executive vice president for the Division of Healthcare Quality Evaluation at The Joint Commission, is the inaugural editor-in-chief of The Joint Commission Journal on Quality and Patient Safety.

    Also known as Joint Commission Journal on Quality Improvement and Joint Commission Journal on Quality and Safety
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