Abstract

Purpose: There are no uniform guidelines for insulin infusion, and therefore hospitals use different insulin infusion protocols to maintain the optimal blood glucose level (BGL). This study evaluates the efficacy of a new insulin infusion protocol (IIP) developed by the Surgical Intensive Care Unit (SICU) at the Samsung Medical Center for surgical ill patients.
Materials and Methods: We considered a total of 246 patients admitted to the SICU at the SMC between August 2010 and January 2012. Over the course of four months, we developed a new IIP for the intensive care unit (ICU) based on a literature review and applied it from July 2011. Before the new IIP, we used a fixed insulin dose according to the checked blood sugar level (BSL), but with the new IIP, we used a flexible insulin infusion rate by considering the variance of the BSL. The BGL ranged from 140 mg/dl to 180 mg/dl. We compared the BGL and clinical outcomes between the old and new IIPs.
Result: There was no difference between participants except for the prevalence of diabetes. The new IIP reduced the average/minimum/maximum BGLs (mg/dl) from 207.9/152.7/268.5 to 181.4/138.7/230.8 (P=0.000/0.005/0.000) as well as the mortality rate, although this decrease was not significant. There was no change in the frequency of hypoglycemia. The results of a subgroup analysis indicate that the new IIP better controlled the BGL regardless of the presence of diabetes.
Conclusion: The new IIP, by considering the variance of the BSL, can control the BGL without increasing the morbidity rate in surgical ICUs. That is, the proposed IIP may be a safe, simple, and effective tool for controlling the BGL in surgical ill patients. (SMN 2012;3:23-28)

• Keywords: Insulin, Intensive care unit, Hyperglycemia, Glucose