Evaluation of effectiveness and safety of an ICU insulin infusion protocol

Queenie Ngalob; Cecilia Jimeno; Iris Thiele Isip-tan

Return

Evaluation of effectiveness and safety of an ICU insulin infusion protocol

Author: Queenie Ngalob ¹ ; Cecilia Jimeno ² ; Iris Thiele Isip-Tan ³
Author Information

1. Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of the Philippines-Philippine General Hospital Manila
2. Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of the Philippines-Philippine General Hospital Manila Department of Pharmacology, College of Medicine, University of the Philippines Manila
3. Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of the Philippines-Philippine General Hospital Manila Medical Informatics Unit, College of Medicine, University of the Philippines Manila
Publication Type:Journal Article
Keywords: Iinsulin infusion protocol; Filipino
MeSH: Hyperglycemia; Intensive Care Units
From: Journal of the ASEAN Federation of Endocrine Societies 2014;29(1):33-41
CountryPhilippines
Language:English
Abstract: Objective:To evaluate the efficacy, safety, and clinical outcomes of, and protocol deviations with the use of the Modified Yale Insulin Infusion Protocol (IIP) compared to usual/standard care in the local setting.
Methods:Chart review of patients admitted in two ICUs over a 2-year period was done. Patients eligible for intensive glycemic control were identified. Efficacy, safety and clinical outcomes were compared between the Modified Yale IIP and usual/standard care. Charts managed with the IIP were appraised for protocol deviations.
Results:Eighty-one patients met the inclusion criteria and 34.6% used the IIP. The IIP group achieved a lower mean blood glucose (185.1 vs 212.1 mg/dl, p<0.05). They reached normoglycemia (5 vs 12 hours, p<0.05) and target range of 140-180 mg/dl (8.3 vs 18.3 hours, p<0.05) earlier. Hypoglycemia was rare (median 0%) in both groups. No difference in mortality or morbidity was seen. Hospital (13.9 vs 8.1 days, p<0.05) and ICU stay (5.5 vs 3.0 days, p<0.05) were longer in the IIP group. A mean of 11 deviations per patient occurred, the majority of which were errors on insulin dose administered (66.6%).
Conclusion:The Modified Yale IIP is efficaceous, safe and yielded better glycemic profiles than usual care. Majority of protocol deviations were on the insulin dose administered
Full text:113-Article Text-552-1-10-20140531.pdf