DOI: 10.1097/01.ccm.0000457826.29620.a1

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Issn Print: 0090-3493

Publication Date: 2014/12/01


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329: COMPARISON OF INSULIN INFUSION METHODS IN CRITICALLY ILL PATIENTS

Carrie Zechmeister; Amanda Fesko; Rachel Leis; Deidre Rohaley

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Author Information: Spectrum Health, Grand Rapids, MI

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Excerpt

Learning Objectives: Glycemic control remains a difficult issue in critically ill patients. Although numerous insulin infusion protocols are available, there exists a paucity of studies comparing different methods. This study aimed to demonstrate that an insulin multiplier based protocol is safe and efficacious when compared to a basal/bolus infusion method in critically ill patients with a target blood glucose (BG) of 140-180 mg/dL.
Methods: This retrospective, observational before and after study evaluated adult intensive care unit (ICU) patients admitted to a 450 bed Level 1 tertiary care center with at least six hours of continuous intravenous insulin. Two time frames were studied: the pre-implementation group (May 2013 to October 2013) utilized a basal/bolus infusion method, and the post-implementation group (November 2013 to February 2014) utilized a multiplier method. Categorical variables were described using frequency distributions and continuous variables as means with standard deviations. Multivariate analysis was conducted to adjust for confounding variables.
Results: A total of 52 patients (31 basal/bolus and 21 multiplier) were included. Crude analysis showed a decreased time to goal BG in the multiplier group (4.1 versus 6.1 hours, P = 0.0016). This effect persisted after adjustment for potential confounding variables. No differences existed for average insulin infusion rate (5.1 units/hour for basal/bolus versus 5.7 units/hour for multiplier, P = 0.50) or percent time in goal range (42.6% for basal/bolus versus 50.7% for multiplier, P = 0.23). Hypoglycemic episodes (including severe hypoglycemia) were infrequent and similar between both groups. Additionally ICU length of stay, hospital length of stay, and discharge disposition did not differ.
Conclusions: The multiplier method is safe and efficacious for insulin infusions when targeting a goal BG of 140-180 mg/dL which resulted in a quicker time to goal BG in the study population. Further studies are needed to continue to assess safety data.
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