Evaluation of an intensive insulin transition protocol in the intensive care unit setting: a before and after study.
The benefits of controlling blood glucose levels in intensive care units (ICUs) are well documented. Objective: This study determined the effectiveness and safety of a standardized transition order set for converting a continuous insulin infusion to a subcutaneous insulin regimen in non-cardiovascul...
| Publicado en: | Pharmacy Practice (1886-3655) Vol. 10; no. 1; pp. 45 - 52 |
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| Autores principales: | , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Centro de Investigaciones y Publicaciones Farmaceuticas S.L.
Jan-Mar2012
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=74091312&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 74091312 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 1885642X 3EAU jtl: Pharmacy Practice (1886-3655) issn: 1885642X maglogo: N pubinfo: dt: Jan-Mar2012 vid: 10 iid: 1 pid: 36266 pub: Centro de Investigaciones y Publicaciones Farmaceuticas S.L. artinfo: ui: 74091312 104547592 104547592 10.4321/S1886-36552012000100008 74091312 ppf: 45 ppct: 7 formats: fmt: @attributes: type: P tig: atl: Evaluation of an intensive insulin transition protocol in the intensive care unit setting: a before and after study. aug: au: JACOBSON, Leigh Anne JERGUSON, Kathleen SPIVA, LeeAnna FRASER, Danielle affil: Clinical Pharmacist, WellStar Kennestone Hospital, Marietta, GA (United States) sug: subj: Intensive Care Units Protocols Standards Insulin Administration and Dosage Blood Glucose Metabolism Hypoglycemic Agents Administration and Dosage Infusions, Intravenous Injections, Subcutaneous Patient Care Plans Standards Postoperative Care Methods Retrospective Design Human Male Female Adult Aged Middle Age Aged, 80 and Over Practice Guidelines Georgia Data Analysis Software Descriptive Statistics Kruskal-Wallis Test Mann-Whitney U Test Record Review Analysis of Variance Chi Square Test Post Hoc Analysis Hyperglycemia Drug Therapy Hypoglycemia Drug Therapy Adult: 19-44 years Aged: 65+ years Middle Aged: 45-64 years Aged, 80 & over Male Female ab: The benefits of controlling blood glucose levels in intensive care units (ICUs) are well documented. Objective: This study determined the effectiveness and safety of a standardized transition order set for converting a continuous insulin infusion to a subcutaneous insulin regimen in non-cardiovascular surgery ICUs patient population. Methods: A retrospective study was conducted. Patients presenting with diabetic ketoacidosis or hyperosmolar hyperglycemic syndrome were excluded. One hundred patients were included prior to and 100 patients were included after initiating the transition order set. Blood glucose control was reviewed for up to 72 hours following the transition. Results: A total of 115 patients were included in data analysis: 85 prior to and 30 after transition protocol. All patients transitioned using the protocol were transitioned to basal insulin, compared to only 40% of the prior to protocol group. Patients transitioned correctly per the transition order set, "per protocol," had 54% of blood sugars within the desired range, no increase in hypoglycemic events, and on average 5.56 hyperglycemic events (blood glucose >180 mg/dL) per person during the 72 hours compared to 6.68 and 9.00 for the prior to protocol group and the "off protocol" group (transitioned different than the protocol recommended), respectively (p= 0.05). There were significant differences in blood sugar control at 48 and 72 hours between the "per protocol" and "off protocol" groups (p= 0.01) and a 40% reduction in sliding scale or correctional insulin coverage. Conclusion: The addition of basal insulin to transition regimens resulted in fewer hyperglycemic events with no increase in hypoglycemic events. Patients transitioned "per protocol" had better glucose control demonstrated by: less hyperglycemic events, lower mean blood glucose levels at 48 and 72 hours, and lower need for correctional insulin. These findings showed benefits of glycemic control in the ICU by following a standardized transition protocol. Los beneficios de controlar la glucemia en las unidades de cuidados intensivos (UCI) están ben documentados. Objetivo: Este estudio determinó la efectividad y seguridad de un orden de transición estandarizado para convertir un régimen de insulina de infusión continua a un régimen de insulina subcutánea en una población de pacientes de UCI de cirugía no vascular. Métodos: Se realizó un estudio retrospectivo. Se excluyó a los pacientes que presentaban cetoacidosis diabética o síndrome hiperglucémico hiperosmolar. Se incluyo a 100 pacientes antes y después de iniciar el sistema de transición. Se revisó la glucemia hasta 72 horas después de la transición. Resultados: Un total de 115 pacientes fueron incluidos para el análisis de datos: 85 antes y 35 después del protocolo de transición. Todos los pacientes que transitaron usando el protocolo pasaron a insulina basal, comparados con sólo el 40% del grupo de antes del protocolo. El 54% de los pacientes que transitaron correctamente con el protocolol, "por protocolo" tuvieron la glucemia en el rango deseado, sin aumento de eventos hipoglucémicos, y con un 5,56% de eventos hiperglucémicos (glucemia>180 mg/dL) durante las 72 horas de vigilancia, comparados con el 6,68% y 9,00% respectivamente para el grupo anterior al protocolo y el grupo "fuera de protocolo" (que transitó diferente a lo recomendado por el protocolo) (p=0,05). Hubo diferencia significativas en el control glucémico a las 48 y 72 horas entre los grupos "por protocolo" y "fuera de protocolo" (p=0,01) y un 40% de reducción en la escala descendente o cobertura de insulina de corrección. Conclusión: La adición de insulina basal a los regímenes de transición provocó menores eventos hiperglicémicos sin aumento de eventos hipoglicémicos. Los pacientes que transitaron "por protocolo" tuvieron mejor control glucémico, demostrado por: menores eventos hiperglucémicos, menores niveles medios de glucemia a las 48 y 72 horas, y menor necesidad de corrección de insulina. Estos hallazgos demostraron los beneficios de un control glucémico en la UCI siguiendo un protocolo estandarizado de transición. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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