Intensive Glycemic Management in Critically Ill Patients

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.