Glucose Control in the Critically Ill Patient Utilizing Computerized Intravenous Insulin DosingArticle
Hyperglycemia and hypoglycemia in the critically ill patient are associated with increased morbidity and mortality. numerous studies have investigated the benefits of glucose control in the critically ill patient receiving intravenous insulin. Tight glucose control (blood glucose 80–110 mg/dl) in this patient population has been difficult to achieve. When accomplished, it has been accompanied by an increased risk of hypoglycemia and in some studies increased mortality. Computer-guided glucose management systems (CGGMS) offer an alternative to paper protocols for the attainment of improved glucose control in critically ill patients requiring intravenous insulin. CGGMS provide a way to achieve improved glucose control with reduced hypoglycemia while reducing insulin infusion calculation errors and standardizing insulin therapy, thus improving patient safety.
Glycemic control using intravenous insulin has been shown to improve outcomes in critically ill as well as non-critically ill patients. The appropriate control of blood glucose in the ICU is a demanding process complicated by the critical and complex patient who often presents with numerous co-morbid conditions.
Although the entity of tight glucose control is difficult to attain and the evidence-based data cannot be objectively compared, at present the use of CGGMS has introduced a treatment modality that affords an opportunity to accomplish appropriate blood glucose goals utilizing complicated mathematics not amenable to bedside use with the potential of a very low incidence of hypoglycemia and improved patient safety.
Essential Success Factors for Computer-guided Glucose Management Systems
CGGMS can help reduce the risk of insulin infusion calculation errors and standardize insulin therapy.
The CGGMS should be integrated into the workflow of the nursing staff with the clinical decision at the point-of-care.
Trained & Informed Users
The systems must facilitate the appropriate use of scheduled insulin therapy administered by nursing staff that is educated and knowledgeable in glycemic management.
Author(s): Samuel E Crockett , MD, Associate Professor of Medicine, Department of Medical Education
Location: University of Central Florida College of Medicine
Publication: US Endocrinology (Volume 5)
Date: November 30, 2009