Practical aspects of intensive insulinization in the intensive care unit

Abstract

Attainment and preservation of glycemic control among critically ill patients are best attempted with intravenous insulin infusion. Advances in the design of decision support and insulin delivery systems, and progress in the technology of continuous blood glucose monitoring, are likely to reduce the risk of hypoglycemia, without compromise of target range control, such that the patient outcomes enjoyed by experienced centers in the future will prove generalizable to others through the extension of new technologies.

Blood Glucose Control by a Model Predictive Control Algorithm with Variable Sampling Rate Versus a Routine Glucose Management Protocol in Cardiac Surgery Patients: A Randomized Controlled Trial

“…Numerous glucose management protocols have been developed to achieve tight glycemic control, including computer-based algorithms (21)(22)(23)(24)(25). Within the European Commission Closed Loop Insulin Infusion in Critically Ill Patients project, which aims to develop an automated system for blood glucose control in critically ill patients, we developed a computer algorithm for tight glucose control [model predictive control (MPC)] and compared it with standard glucose management protocols in three different European cardiovascular centers (26).…”

Target Attainment Through Algorithm Design During Intravenous Insulin Infusion

“…23 This report from Saint Francis Hospital of the performance of algorithms having three different target ranges 5,6 represents a milestone in the development from predecessor paper tabular algorithms, having similar format but different target ranges. 7,[24][25][26][27] The long-range goal is to achieve full computerization. 28 The reported algorithms here introduce use of a nearly sigmoidal relationship of IR as a function of BG, such that each algorithm has an inflection point at BG close to true target.…”

Peers, Regulators, and Professions

“…Although mortality reduction is a clear goal, the steps to achieve it are ambiguously defined in the Leuven protocol. 11 A large number of confounding variables in clinician behavior and patient demographics also can complicate IIT delivery. Furthermore, metrics for understanding protocol performance and comparing study sites are not widely accepted.…”

“…Within a health care organization, IIT diffusion among hospital units may be due to local patterns of socialization amongst clinicians as reported at one institution. 11 It is conceivable that a faculty member may present the results of a local IIT study at grand rounds, which prompts other faculty members to consider implementation in their care units.…”