Adapting to the New Consensus Guidelines for Managing Hyperglycemia During Critical Illness: The Updated Yale Insulin Infusion Protocol.
Endocr Pract. 2011 Dec 2;:1-19
Authors: Shetty S, Inzucchi SE, Goldberg PA, Cooper D, Siegel MD, Honiden S
Objective: The current AACE/ADA consensus statement stresses a less stringent blood glucose (BG) target (140-180 mg/dl) in the intensive care unit (ICU) than was previously endorsed. Since 2003, we have utilized a standardized IV insulin infusion protocol (IIP), initially targeting 100-140 mg/dl, revised in 2005 to 90-120 mg/dl. Both have been validated and published and are now used in many US hospitals. In response to the new guidelines, in 2009 we revised our IIP to target 120-160 mg/dl.Research Design and Methods: We prospectively tracked clinical responses to the new IIP in our medical ICU.Results: The IIP was used 115 times in 90 patients (mean age 62±14 years, 51% male, 35% ethnic minorities, 64% with history of diabetes). The mean admission APACHE-II score was 24.4±7.5. The median duration of insulin infusion was 59 hours. The mean baseline BG was 306.1±89.8 mg/dl, with the BG target achieved after a median of 7 hours. Once the target was reached, the mean IIP BG was 155.9±22.9 mg/dl (median 150 mg/dl.) The median insulin infusion rate required to reach and maintain the target range was 3.5 units/hour. Hypoglycemia was rare, with 0.3% of BGs recorded <70 mg/dl and only 0.02% <40 mg/dl. In all cases hypoglycemia was rapidly corrected using intravenous dextrose with no evident untoward outcomes.Conclusions: The updated Yale IIP provides effective and safe targeted BG control in the critically ill, in compliance with recent national guidelines. It can be easily implemented by hospitals now using the original Yale IIP.
PMID: 22138078 [PubMed - as supplied by publisher]