A randomized controlled trial comparing a computer-assisted insulin infusion protocol with a strict and a conventional protocol for glucose control in critically ill patients

Cavalcanti, Alexandre Biasi; Silva, Eliezer; Pereira, Adriano José; Caldeira-Filho, Milton; Almeida, Francisca Pereira de; Westphal, Glauco Adrieno; Beims, Renate; Fernandes, Caio César Ferreira; Corrêa, Thiago Domingos; Gouvea, Marcos Roberto; Eluf-Neto, José

doi:10.1016/j.jcrc.2009.05.005

Cited by 53 publications

(60 citation statements)

References 21 publications

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“…A randomized controlled trial was conducted to compare three insulin administration protocols in intensive care patients (17) . When this study was complete, a questionnaire was given to all nurses to assess their perceptions about efficacy, complexity, feasibility, and safety (measured by the occurrence of hypoglycemic episodes), as well as which protocol they would you like to see adopted as the standard in their ICU (Supplemental Digital Content / Methods).…”

Section: Methods Participantsmentioning

confidence: 99%

“…Our aim was to evaluate nurses' perception of the efficacy, complexity, feasibility, and safety (measured by the occurrence of hypoglycemic episodes), as well as which protocol they would you like to see adopted as the standard in their ICU, among three different blood glucose control protocols administered to critically ill patients as part of a prospective, randomized, controlled, multicenter trial (17) . The three insulin protocols evaluated in the randomized controlled trial were Computer-Assisted Insulin Protocol (CAIP) (17) , the Leuven Protocol (LP) (1,2) , and conventional treatment (CT).…”

Section: Objectivementioning

confidence: 99%

“…The three insulin protocols evaluated in the randomized controlled trial were Computer-Assisted Insulin Protocol (CAIP) (17) , the Leuven Protocol (LP) (1,2) , and conventional treatment (CT).…”

Section: Objectivementioning

confidence: 99%

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Avaliação da percepção de enfermeiros sobre três protocolos para controle glicêmico em pacientes críticos

Corrêa

Almeida

Cavalcanti

et al. 2012

Einstein (São Paulo)

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Objective: To evaluate nurses' perception regarding three different blood glucose control protocols for critically ill patients. Methods: As part of a randomized trial comparing three blood glucose control protocols in critically ill patients (Computer-Assisted Insulin Protocol, Leuven Protocol, and conventional treatment), all nurses participating in the study were asked to fill in a questionnaire to assess their perceptions of efficacy, complexity, feasibility, and safety (as to the occurrence of hypoglycemic episodes), an to indicate which protocol they would like to see adopted as the standard one in the Intensive Care Unit they worked. Results: Sixty nurses answered the questionnaires. Computer-Assisted Insulin Protocol was considered the most efficient protocol to maintain blood glucose levels within the target range by 58% of the nurses, compared to 22% for Leuven Protocol (p<0.001) and 40% for conventional treatment (p=0.04). Computer-Assisted Insulin Protocol was considered easier to use than Leuven Protocol (p<0.001) and as easy as conventional treatment (p=0.78). Out of the nurses, 37% considered Computer-Assisted Insulin Protocol more feasible than Leuven Protocol and conventional treatment. A total of 51% of nurses chose Leuven Protocol as the protocol more often associated with hypoglycemia, while 27% chose Computer-Assisted Insulin Protocol and 8% conventional treatment. Finally, 56% of the nurses selected Computer-Assisted Insulin Protocol as the protocol they would like to see adopted as the standard one in the Intensive Care Unit they were based, as compared to 22% that selected Leuven Protocol and 15% that selected conventional treatment. Conclusion: Computer-Assisted Insulin Protocol was considered more efficacious, easier to use and safer than Leuven Protocol by nurses. The complexity and feasibility of Computer-Assisted Insulin Protocol were considered similar to conventional treatment. Most nurses chose of Computer-Assisted Insulin Protocol as the protocol they would like to see adopted in their Intensive Care Units. Keywords

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Section: Methods Participantsmentioning

confidence: 99%

Section: Objectivementioning

confidence: 99%

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Avaliação da percepção de enfermeiros sobre três protocolos para controle glicêmico em pacientes críticos

Corrêa

Almeida

Cavalcanti

et al. 2012

Einstein (São Paulo)

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“…The use of subcutaneous (SC) and intravenous insulin (IV) on glycemic control (n=7) [7][8][9][10][11][12][13][14] The study established the number of hypoglycemic events related to critical patients in relation to the administration of IV insulin and SC insulin in the treatment of hyperglycemia.…”

mentioning

confidence: 99%

Glycemic control in patients receiving insulin critics: integrative review

Paixão

Silva

Nepomuceno

et al. 2015

R. pesq. cuid. fundam. online

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Paixão CT, Silva LD, Nepomuceno RM et al. Resultados: El control glicêmico con insulina intravenosa indicó tasas más grandes de hipoglicemia apesar de permitir alcançar la meta alvo mas rápido y protocolos informatizados son recursos eficazes en la prevención de eventos hipoglicêmicos apesar de caros y poco disponibles. Conclusión: És importante que se informe al enfermero acerca de la hipoglicemia grave que ocurre encuanto se administra insulina intravenosa. Descriptores: Insulina,

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“…9 Comparable BG control with a reduction in the incidence of hypoglycemia was reported in other studies comparing computerized to paper-based insulin infusion protocols. [10][11][12] In January 2013 we converted all 4 adult ICUs in our hospital (2 medical and 2 surgical) to a CIIP. In this report we describe the results achieved for mean BG and the incidence of moderate and severe hypoglycemia.…”

mentioning

confidence: 99%

Reducing the Risk of Hypoglycemia Associated With Intravenous Insulin

Sandler

Misiasz

Jones

et al. 2014

J Diabetes Sci Technol

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SymposiumThe level of glycemic control needed to improve outcomes without increasing the risk of hypoglycemia in hospitalized patients with critical illness is controversial. Achieving reasonable control of blood glucose without causing an excess risk of hypoglycemia is especially challenging in patients with ESRD, a condition commonly encountered in the critically ill.In 2001, Van den Berghe and colleague's landmark study in a surgical intensive care unit (ICU) suggested that strict blood glucose (BG) control (mean 103 mg/dL) was associated with a mortality and morbidity benefit in comparison to standard therapy (mean 153 mg/dL).1 A subsequent study of patients in the medical ICU however failed to show similar benefits and hypoglycemia was a frequent complication.2 Meta-analysis of multiple studies shows an inconsistent mortality benefit with intensive glycemic control and highlights the increased risk of hypoglycemia.3 More recently, the NICE-SUGAR study compared all-cause and cause-specific mortality and morbidity (new organ failure, bacteremia, redcell transfusion, and volume resuscitation) in over 6100 surgical and medical ICU patients treated either with an intensive insulin regimen (target BG 81-108 mg/dL) or a standard insulin regimen (target BG less than 180 mg/dL). 4 This trial concluded that intensive BG control was associated with a significant increase in the incidence of both moderate hypoglycemia (BG 41-70 mg/dL), and severe hypoglycemia (BG ≤ 40 mg/dL). Both degrees of hypoglycemia were associated with increased all-cause mortality, and particularly cardiovascular mortality. 5The cumulative effect of repeated hypoglycemia-related stress responses increases the risk of cardiac arrhythmias, neurological impairment, seizures, and death. [5][6] In light of AbstractComputerized insulin infusion protocols have facilitated more effective blood glucose (BG) control in intensive care units (ICUs). This is particularly important in light of the risks associated with hypoglycemia. End stage renal disease (ESRD) increases the risk of insulin-induced hypoglycemia. We evaluated BG control in 210 patients in 2 medical ICUs and in 2 surgical ICUs who were treated with a computerized insulin infusion program (CIIP). Our CIIP was programmed for a BG target of 140-180 mg/dL for medical ICU patients or 120-160 mg/dL for surgical ICU patients. In addition, we focused on BG control in the 11% of our patients with ESRD. Mean BG was 147 ± 20 mg/dL for surgical ICU patients and 171 ± 26 mg/ dL for medical ICU patients. Of both surgical and medical ICU patients, 17% had 1 or more BG 60-79 mg/dL, while 3% of surgical ICU and 8% of medical ICU patients had 1 or more BG < 60 mg/dL. Mean BG in ESRD patients was 147 ± 16 mg/dL similar to 152 ± 23 mg/dL in patients without ESRD. Of ESRD patients, 41% had 1 or more BG < 79 mg/dL as compared with 17.8% of non-ESRD patients (P < .01). A higher BG target for medical ICU patients as compared with surgical ICU patients yielded comparably low rates of moderate or severe hypoglycemia....

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A randomized controlled trial comparing a computer-assisted insulin infusion protocol with a strict and a conventional protocol for glucose control in critically ill patients

Abstract: The CAIP is safer than and as effective as the standard strict protocol for controlling glucose in MICU patients. Hypoglycemia was rare under conventional treatment. However, BG levels were higher than with IV insulin protocols.

Cited by 53 publications

References 21 publications

Avaliação da percepção de enfermeiros sobre três protocolos para controle glicêmico em pacientes críticos

Avaliação da percepção de enfermeiros sobre três protocolos para controle glicêmico em pacientes críticos

Glycemic control in patients receiving insulin critics: integrative review

Reducing the Risk of Hypoglycemia Associated With Intravenous Insulin

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