Computerized Insulin Infusion Programs Are Safe and Effective in the Burn Intensive Care Unit

Abstract

Glucose control has repeatedly been shown to influence favorable outcomes in the surgical intensive care unit (ICU). Intensive insulin therapy has recently been associated with reduced infections complications in burn patients. However, traditional protocols are associated with rates of severe hypoglycemia as high as 19%. Two commercial computer glucose control programs have reported rates of severe hypoglycemia (glucose <50 mg/dl) of 0.6 and 0.4%. Recently, the authors' burn ICU adopted an intensive insulin computer-based protocol created at their institution and already successfully in use in their surgical ICU. The authors hypothesized that their protocol can be used effectively in the burn patient population without an increase risk of severe hypoglycemia. All patients admitted to the burn ICU have blood glucose (BG) values checked routinely. With two consecutive hyperglycemic values >200 mg/dl, patients are placed on a computer-based protocol intravenous insulin drip. Once initiated, BGs are tested hourly with adjustments made according to the computer protocol. Values recorded from January to December 2008 were abstracted from the database and analyzed. Thirty-one patients were treated using the computer glucose control protocol and 12,699 measurements were performed. There were eight measurements <50 mg/dl (0.07%). Seventy-six percent of values were within the target range of 90 to 150 mg/dl. Few patients had severe hyperglycemia with BG >300 mg/dl (0.2%). There were no adverse events associated with the hypoglycemic episode. The computer-based protocol is more effective than those previously used at the institution and provides safe, reliable results in the burn patients.

Practical approach to clinical controversies in glycemic control for hospitalized surgical patients

“…These programs have been assessed in a variety of studies and have been associated with a higher amount of time in the target serum glucose range and fewer hypoglycemic events 33–35 . One assessment also noted that nursing satisfaction was improved when utilizing software‐based protocols 35 .…”

“…These programs have been assessed in a variety of studies and have been associated with a higher amount of time in the target serum glucose range and fewer hypoglycemic events. [33][34][35] One assessment also noted that nursing satisfaction was improved when utilizing software-based protocols. 35 One observational study specifically assessed the benefits with software-based protocols compared with a paper-based multiplication factor protocol in critically ill surgical patients.…”

Japanese Society for Burn Injuries (JSBI) Clinical Practice Guidelines for Management of Burn Care (3rd Edition)

“…and Sood et al . reported that IIT using a computer program resulted in good control and very low rate of hypoglycemic events 11,12 …”

Improving Hospital Glucometrics, Workflow, and Outcomes with a Computerized Intravenous Insulin Dose Calculator Built into the Electronic Health Record

“…We collaborated with another institution that had successfully implemented a similar algorithm as a stand-alone tool outside the EHR. 9 Armed with the shared learnings, we integrated the calculator into our EHR (Epic), instituted it in the cardiovascular intensive care unit (CVICU), and customized the clinical workflow based on our institution-specific practices. We aim to describe the design of the calculator, the implementation process, best practices, and evaluate its impact.…”