Avaliação da efetividade e segurança do protocolo de infusão de insulina de Yale para o controle glicêmico intensivo

Abstract

JUSTIFICATIVA E OBJETIVOS: O controle glicêmico intensivo ocupa lugar de destaque no manuseio dos pacientes críticos. O objetivo desde estudo foi avaliar a efetividade e a segurança do protocolo de insulinoterapia por via venosa de Yale nos pacientes críticos internados em unidade de terapia intensiva geral em hospital comunitário. MÉTODO: Foi realizado um estudo retrospectivo e comparativo entre 2 coortes de pacientes críticos, antes e após a implantação do controle glicêmico intensivo. Os desfechos de interesse do estudo foram glicemia média durante o tratamento, tempo para atingir a faixa alvo de 80 a 140 mg/dL, percentual de glicemia

Valores glicêmicos oferecidos pelo glicosímetro portátil, utilizando sangue de diferentes vias de coleta: estudo de validade

“…This unit uses continued insulin venous infusion, with blood glucose monitoring according to the Yale Protocol. (1,4) To achieve our overall objective, the following specific objectives were established: to identify the blood glucose values using three different accesses usual in the ICU, i.e., capillary blood, arterial blood and central venous blood, using reagent test strips; to compare the portable blood glucose meter readings and laboratory analysis results; to identify the impact of vasoactive drugs, edema and reduced peripheral perfusion on the finger tip capillary blood readings and consequently on the insulin protocol management.…”

“…Therefore, accurate blood glucose measurement is a must for appropriate patient's therapy. (1)(2)(3)(4) Van den Berghe et al (5) study became a landmark for ICU blood glucose control, showing that use of continued insulin solution, maintaining blood glucose between 80 and 110 mg/dL, significantly reduced critically ill patients' mortality and complications rates.…”

“…However, severely ill patients' finger tip samples were shown to provide inaccurate readings, due to poor peripheral perfusion from several causes, such as vasoactive drugs, edema and microcirculation disorders, and may lead to inappropriate insulin solution flow management. (6,7) Ana Paula Bello Argollo 1 Other than finger tip sources may be used, as central venous and arterial sampling. Frequently the nursing team uses blood from central venous access, drawn for laboratory tests, also for portable blood glucose meter readings.…”

Preventive Strategies of Adverse Events With Potentially Dangerous Medications

“…That said, we recommend some strategies necessary for a safe administration of the single insulin type that can be intravenously administered (regular insulin), which will be hereinafter considered. 28 The intravenous regular insulin administration should strictly occur in continuous infusion pump and its dosage should strictly be controlled, with sights to avoid hypoglycemia. …”

Drug Interaction Exposures in an Intensive Care Unit: Population Under Antihypertensive Use

“…The main complication of insulin therapy is hypoglycemia which is considered a potentially serious adverse event in these patients (Diener et al, 2006). The combination of a beta-blocker and insulin may impose a higher risk of blood glucose changes and lead to the development of hypoglycemia, hyperglycemia and hypertension.…”