Yale insulin protocol infusion in sepsis patients

Abstract

Introduction Fibrinolytic shutdown plays a pivotalrole in the pathogenesis of multiple organ dysfunction syndrome (MODS) in disseminated intravascular coagulation (DIC). We tested the hypothesis that the levels of thrombin activatable fi brinolysis inhibitor (TAFI) are not suffi cient to overcome fi brinolytic shutdown, thus contributing to MODS and the poor prognosis in sepsis-induced DIC. Methods Fifty patients with sepsis, severe sepsis, or septic shock were enrolled in the study. The DIC was diagnosed based on the Japanese Association for Acute Medicine (JAAM) DIC criteria. The overt DIC scores based on the International Society on Thrombosis and Haemostasis (ISTH) were also calculated. On the day of sepsis diagnosis (day 1), and days 3 and 5, we measured TAFI, soluble fi brin, and global coagulation and fi brinolysis markers. Results The JAAM DIC scores on day 1 and maximum JAAM DIC scores were independent predictors of patient death and MODS, respectively. The JAAM DIC patients, especially those who simultaneously met the ISTH overt DIC criteria, showed lower TAFI antigen levels and activity, and higher levels of soluble fi brin in comparison with non-DIC patients. There were diff erences in the levels of soluble fi brin and TAFI activity between the patients with and without MODS. The fi ndings of stepwise logistic regression and multiple regression analyses suggested that low TAFI activity is an independent predictor of patient death and MODS. A multiple regression analysis also indicated that soluble fi brin negatively correlated with the TAFI activity in DIC patients. Conclusion Thrombin activation results in the consumption of TAFI. Low TAFI activity is involved in the pathogenesis of DIC-induced MODS and poor prognosis.

Evaluation of Effectiveness and Safety of an ICU Insulin Infusion Protocol

“…15 These favorable results were likewise reported in centers in Brazil, Portugal and the US. [16][17][18] In our study, a substantial number of protocol deviations occurred. The most frequent deviation was on improper insulin dose adjustment followed by improper timing of BG checks.…”

“…[15][16][17][18] In the study of Tamaki, et al, conducted in Japan, a cohort of 40 cardiac surgery patients were compared to a historical cohort of 35 patients.…”

Don’t Sugar Coat It: Glycemic Control in the Intensive Care Unit

“…44 Multiple other protocols have been developed with varying accuracy, perhaps one of the most widely used is the Yale protocol. 45 A study that compared the Yale protocol to the protocol used in the Leuven studies revealed that patients treated under the Yale protocol had better than average glucose control with less hypoglycemic events. 46 However, a major drawback of using protocols for glucose control is that it requires a large time commitment from clinical staff and is associated with increased costs.…”