Efficiency of Computerized Insulin Infusion Glucose Control in Critically Ill Patients

• Published in: Journal of acute care surgery Vol. 10; no. 2; pp. 53 - 57
• Main Authors: Lim, Hee Jung, Park, Chi-Min, Gil, Eunmi, Yoo, Keesang, Choi, Kyoung-Jin, Jin, Sang-Man
• Format: Journal Article
• Language: English
• Published: Korean Society of Acute Care Surgery 01.07.2020; 대한외상중환자외과학회
• Subjects: hyperglycemia; hypoglycemia; insulin; intensive care units; 일반외과학
• ISSN: 2288-5862; 2288-9582
• DOI: 10.17479/jacs.2020.10.2.53

Purpose Intensive IV insulin infusion therapy has been applied widely to critically ill patients. However, IV insulin protocols are complex, and require repeated calculations. The purpose of this study was to evaluate the safety and efficiency of a computerized insulin infusion (CII) protocol to replace manual insulin infusion protocols, for glucose control in critically ill patients. Methods This was an observational study (September 2016 to January 2017) of 43 patients in ICU whose blood glucose level was between 140–180 mg/mL and could not be controlled by the conventional manual insulin protocol. The CII protocol was integrated in to the electronic medical record order system, and automatically calculated the insulin infusion dose and blood sugar test (BST) interval. BSTs were taken 48 hours pre- and post-initiation of the CII protocol. The proportion of BSTs in the normal (70–180 mg/mL), hypoglycemic (70 mg/mL), and severe hyperglycemic (> 250 mg/mL) range were recorded. Results The mean number of BSTs performed before using the CII protocol was 10.3/person and 0.4/hour, and after implementing the protocol, increased to 21.7/person and 0.7/hour. The mean glucose level (281.4 mg/mL) decreased after using the CII protocol (195.5 mg/mL; p < 0.001). The percentage of BSTs within normal range increased from 22.5% to 44.9% after implementing the protocol (p < 0.001). Severe hyperglycemia (> 250 mg/mL) decreased from 47.3% to 17.9% after protocol implementation (p = 0.020). Conclusion The CII protocol safely and successfully maintained a normal glucose range, and decreased severe hyperglycemia in intensive care patients.