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Protocol improves ICU glucose levels

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Adopting a nurse-led insulin-infusion protocol to maintain therapeutic blood glucose levels in ICU patients significantly improves glycaemic control, a Norwegian study has confirmed.

Nurse researchers implemented an algorithm for strict glycaemic control (SGC), aiming for arterial blood glucose levels of 4.4–6.1 mmol/l.

They analysed the blood sugar levels of 448 patients admitted to an 11-bed general ICU over 32 months. The results were then compared with the blood glucose levels of 494 patients admitted to the ICU 20 months prior to SGC implementation.

Before SGC was started, 33% of samples showed blood glucose levels of 4.4–6.1mmol/l. Following implementation of the algorithm, this rose to 45.8%.

‘Hyperglycaemia and insulin resistance are common in critically ill patients,’ the authors said, pointing out that elevated blood glucose is related to long- and short-term higher morbidity and mortality, dependence on mechanical ventilation and length of hospital stay.

‘Hyperglycaemia has also consistently been shown to be associated with severity of brain damage in head-injured patients or those with anoxic coma,’ they added.

Tracy Pilcher, consultant nurse in critical care at United Lincolnshire Hospitals Trust, said that SGC was now common practice in ICU settings in the UK.

‘However, hypoglycaemia is a problem,’ she said. ‘Although people started with the 4.4–6.1 mmol/l approach advocated in this study, most ICUs have moved to a more liberal strategy of maintaining blood sugars of 4–8mmol/l to try and overcome the issues in relation to hypoglycaemia.’

But Rachel Binks, nurse consultant in critical care at Airedale NHS Trust, warned that an improvement in glycaemic control did not always mirror an improvement in outcome.

BMC Nursing (2008)

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