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Computerized Insulin Infusion Works in ICU Patients

Posted: Wednesday, September 16, 2009

A computer-aided insulin infusion protocol maintains glucose control in the ICU as effectively as a strict glycemic control protocol, and both of these methods are more effective than conventional treatment, researchers report.

Dr. Alexandre B. Cavalcanti of Hospital Israelita Albert Einstein, Sao Paulo, and colleagues came to this conclusion after randomizing 167 ICU patients to glucose control using one of the three methods. All patients had at least one blood glucose measurement of 150 mg/dL and at least one of the following: systemic inflammatory response syndrome, trauma, burns, or need for mechanical ventilation.

The computer-assisted protocol was designed by the researchers to be safe and easy to use, and to maintain blood glucose between 100 and 130 mg/dL, according to the article.

In the strict protocol, continuous IV insulin was administered with adjustments to keep blood glucose between 80 and 110 mg/dL. The conventional protocol employed standard intermittent subcutaneous insulin, given on sliding scale when blood glucose was above 150 mg/dL.

The mean of patients' median blood glucose was 125.0 mg/dL with the computer-aided protocol, 127.1 mg/dL for the strict protocol, and 158.5 mg/dL for the conventional approach.

Twelve patients in the computer group (21.4%), 24 strict protocol patients (41.4%), and 2 (3.8%) conventionally treated patients had at least one episode of hypoglycemia.

"The conventional protocol," the researchers point out, "led to a minimal risk of hypoglycemia, although it was clearly inferior to the intravenous protocols in avoiding hyperglycemia."

A survey of the 60 nurses involved in the study showed that 56% would like the computer protocol to become standard in their ICU, 22% prefer the strict protocol and 15% prefer the conventional protocol. The remaining 7% believed the protocols were alike.

Dr. Cavalcanti stated that his team's tool is "freely available" and that it safely achieved glucose control within the 100-130 mg/dL range in critically ill patients. "Moreover," he said, "it was considered easy to use and thus was very well accepted by the nursing staff."

Source: Diabetes In Control: Journal of Critical Care, Sept. 2009;24:371-378.