Glycemic control in people in critical condition
“16 years in the path towards quality and safety "
DOI:
https://doi.org/10.29352/mill0212e.29278Keywords:
nursing; people in critical condition; insulin; hypo/hyperglycemia; protocolAbstract
Introduction: Glycemic control in people in critical condition was implemented in an intensive care unit in 2003. Based on the publications of Dr. Greet Van Den Berghe and collaborators, a working group was created, and an action plan algorithm was designed. This algorithm underwent several changes, which were supported by scientific evidence and internal audits, to assess its effectiveness and safety.
Objective: Verification of the safety and effectiveness of the protocol and the implications for nursing workload.
Methods: Quantitative study of a prospective nature, data collection was carried out using a collection instrument prepared by the working group and statistical treatment using the Excel program.
Results: The evolution from 2003 to 2019 is evidenced by the results and respective critical analysis of three audits carried out at different periods, with actual samples of 115, 61, and 112 patients, respectively, in which the different protocols for glycemic control with administration of continuous intravenous insulin infusion, applied in the unit, were effective and safe, and hypoglycemia did not translate into major complications (0.09%; 0.02% e 0,1% respectively).
Conclusion: These results were mainly driven by the nursing team's ability to monitor and manage its responsibilities and less driven by the pre-defined goals of each protocol's blood glucose control.
Since September of 2018, we use the modified Yale.
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References
American Diatetes Association (2018). Diabetes Care in the Hospital: Standards of Medical Care in Diabetes – 2018. Diabetes Care, 41 (1), S114-S151. https://doi.org/10.2337/dc18-S014
Couto, D., Barbosa, K., Silva, M., Carvalho, M., Silva, F., Viana, A. (2021). Protocolos de manejo de hiperglicemia em paciente crítico e não crítico em ambiente hospitalar. Revista Baiana de Saúde Pública, n45 n.supl.2, 8-23. https://doi.org/10.22278/2318-2660.2021.v45.NSupl_2
De Block, C.E.M., Rogiers, P., Jorens, P.G., Shepens, T., Scuffi, C., & Van Gaal, L.F. (2016). A comparison of two insulin infusion protocols in the medical intensive care unit by continuous glucose monitoring. Annals of Intensive Care 6, 115. https://doi.org/10.1186/s13613-016-0214-9
Diário da República, 2.ª série (2011) — N.º 35 — 18 de Fevereiro de 2011. Regulamento n.º 124/2011, de 18 de Fevereiro, p.8656. https://diariodarepublica.pt/dr/detalhe/regulamento/124-2011-3477013
Godinho, C., Jordão, A., Dias, A., Lopes, A., Duarte, A., Carvalho, D., Nascimento, E., Carrasqueira, H., Louro, J., Ricciulli, M., & Melo, M. (2015). Joint Recommendations of the Portuguese Diabetology Society (SPD)/Portuguese Internal Medicine Society (SPMI) on the Management and Treatment of Hyperglycemia in Non Critical Hospital Inpatients. Suplemento da Revista da Sociedade de Medicina Interna, 10 (3). https://www.spmi.pt/wp-content/uploads/NEDM_262.pdf
Jacobi, J., Bircher, N., Krinsley, J.S., Agus, M.S.D., Braithwaite, S.S., Deutschman, C.S., Freire, A., Geehan, D., Kohl, B., Nasraway, S.A., Rigby, M. R., Sands K., Schallom, M.E., Taylor, B.E., Umpierrez, G.E., Mazuski, J.E., & Schunemann, H. (2012). Guidelines for the use of an insulin infusion for the management of hyperglycemia in critically ill patients. Critical Care Medicine, 40 (12), 3251-3276. https://www.researchgate.net/publication/233723718
Marvin, M. R., Inzucchi, S. E., & Besterman, B. J. (2016). Minimization of Hypoglycemia as an Adverse Event 8. During Insulin Infusion: Further Refinement of the Yale Protocol. Diabetes Technology & Therapeutics, 18 (8), 480-486. https://doi.org/10.1089/dia.2016.0101
Ngalob, Q., Jimeno, C., & Isip-Tan, I. T. (2014). Evaluation of Effectiveness and Safety of an ICU Insulin Infusion Protocol. Journal of the ASEAN Federation of Endocrine Societies, 29 (1), 33-41. https://doi.org/10.15605/jafes.029.01
The Nice Sugar Studie Investigators. (2009). Intensive versus convencional Glucose Control in critically ill patients. The New England Journal of Medicine, 360 (13), 1283-1297. https://www.nejm.org/doi/pdf/10.1056/NEJMoa0810625?articleTools=true
Van den Berghe, G., Wouters, P. J., Bouillon, R., Weekers, F., Verwaest, C., Schetz, M., Vlasselaers, D., Ferdinande, P., & Lauwers, P. (2003). Outcome benefit of intensive insulin therapy in the critically ill: Insulin dose versus glycemic control. Critical Care Medicine, 31(2), 359–366. https://doi.org/10.1097/01.CCM.0000045568.12881.10
Van den Berghe, G., Wouters, P., Weekers, F., Verwaest, C., Bruyninckx, F., Schetz, M., Vlasselaers, D., Ferdinande, P., Lauwers, P., & Bouillon, R. (2001). Intensive insulin therapy in critically ill patients. The New England Journal of Medicine, 345(19), 1359–1367. https://doi.org/10.1056/NEJMoa011300
Yale Diabetes Center, & Yale-New Haven Hospital. (2009). ICU Insulin Infusion Protocol (IIP) for Adults. http://agrotikosiatros.gr/documents/ICUIPP-Yale.pdf
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