July 22, 2013

Guideline Title

Guidelines for the use of an insulin infusion for the management of hyperglycemia in critically ill patients.

Bibliographic Source(s)

Jacobi J, Bircher N, Krinsley J, Agus M, Braithwaite SS, Deutschman C, Freire AX, Geehan D, Kohl B, Nasraway SA, Rigby M, Sands K, Schallom L, Taylor B, Umpierrez G, Mazuski J, Schunemann H. Guidelines for the use of an insulin infusion for the management of hyperglycemia in critically ill patients. Crit Care Med. 2012 Dec;40(12):3251-76. [222 references] PubMed External Web Site Policy

Guideline Status

This is the current release of the guideline.

Guidelines for the use of an insulin infusion ... [Crit Care Med. 2012] - PubMed - NCBI

2012 Dec;40(12):3251-76. doi: 10.1097/CCM.0b013e3182653269.

Guidelines for the use of an insulin infusion for the management of hyperglycemia in critically ill patients.

Jacobi J, Bircher N, Krinsley J, Agus M, Braithwaite SS, Deutschman C, Freire AX, Geehan D, Kohl B, Nasraway SA, Rigby M, Sands K, Schallom L, Taylor B, Umpierrez G, Mazuski J, Schunemann H.

Source

Indiana University Health Methodist Hospital, Indianapolis, IN, USA. jjacobi@iuhealth.org

Abstract

OBJECTIVE:

To evaluate the literature and identify important aspects of insulin therapy that facilitate safe and effective infusion therapy for a defined glycemic end point.

METHODS:

Where available, the literature was evaluated using Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) methodology to assess the impact of insulin infusions on outcome for general intensive care unit patients and those in specific subsets of neurologic injury, traumatic injury, and cardiovascular surgery. Elements that contribute to safe and effective insulin infusion therapy were determined through literature review and expert opinion. The majority of the literature supporting the use of insulin infusion therapy for critically ill patients lacks adequate strength to support more than weak recommendations, termed suggestions, such that the difference between desirable and undesirable effect of a given intervention is not always clear.

RECOMMENDATIONS:

The article is focused on a suggested glycemic control end point such that a blood glucose ≥ 150 mg/dL triggers interventions to maintain blood glucose below that level and absolutely <180 180="" 70="" a="" accurate="" an="" analysis="" and="" approaches="" appropriate="" arterial="" availability="" avoid="" avoidance="" be="" blood="" calories="" carbohydrate="" cardiac="" care="" charts="" components="" consistent="" control="" designed="" detect="" dextrose="" dl.="" dl="" end="" essential="" finger-stick="" for="" frequent="" general="" glucose="" glycemic="" hypoglycemia="" improvement="" in="" inadequate="" include="" infusion="" injury="" insulin="" intensive="" is="" literature="" management="" mg="" minimize="" monitoring="" morbidity="" mortality="" neurologic="" nutritional="" of="" or="" p="" patients.="" patients="" pediatric="" perioperative="" point="" post-traumatic="" postoperative="" preparation="" prevention="" processes="" program="" programs="" protocol="" provision="" quality="" rates="" recommendations="" reduction="" reductions="" regarding="" regimen="" reliable="" replacement="" resources="" run="" samples.="" should="" slight="" staffing="" standardized="" suggest="" support="" surgery="" system="" technology="" testing="" that="" the="" therapy="" there="" this="" through="" titration="" to="" treatment.="" treatment="" unit="" use="" validated="" values="" variability.important="" venous="" we="" with="">

CONCLUSIONS:

While the benefits of tight glycemic control have not been definitive, there are patients who will receive insulin infusion therapy, and the suggestions in this article provide the structure for safe and effective use of this therapy.