Process management for continuous subcutaneous insulin infusion during enteral nutrition in critically ill patients
10.3760/cma.j.cn115822-20240619-00103-1
- VernacularTitle:持续外周胰岛素输注控制高血糖流程化管理在危重患者肠内营养治疗中的实施效果
- Author:
Ruixia BAI
1
;
Liang JIANG
1
;
Wenxin WANG
1
;
Weitang CAO
1
Author Information
1. 青海红十字医院EICU，西宁 810000
- Publication Type:Journal Article
- Keywords:
Continuous periheral insulin infusion;
Process management;
Enteral nutrition;
Critically ill patients;
Hyperglycaemia
- From:
Chinese Journal of Clinical Nutrition
2025;33(5):372-376
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the role of process management for continuous periheral insulin infusion (CPII) for controlling hyperglycemia during enteral nutrition (EN) for critically ill patients.Methods:A total of 75 patients who received continuous EN treatment in the emergency intensive care unit (EICU) of Qinghai Red Cross Hospital from January 2023 to January 2024 were selected in this historical controlled trial study. Patients who were admitted before the implementation of process management for CPII were included in the historical control group ( n=35), and those who were admitted after the implementation were included in the observation group ( n=40). Both groups were treated with continuous EN infusion combined with micropump-based insulin therapy, with the target blood glucose being<10 mmol/L. The blood glucose values at 4 hours and 8 hours after treatment, the time to reach the target blood glucose and the dosage of insulin, the total amount of insulin at 24 hours, the amount of calories administered when reaching the target blood glucose, the frequency of blood glucose measurement, the incidence of hypoglycemia and hypokalemia, the amount of potassium supplemented for hypokalemia, the length of EICU stay, and the incidence of nosocomial infection were compared between these two groups. Results:The blood glucose levels of the observation group at 4 hours and 8 hours after CPII were significantly lower than those of the control group (both P<0.001), and the time for the observation group to reach the target blood glucose level was significantly shorter than that for the control group ( P<0.001). The total amount of insulin in the observation group when reaching the target blood glucose and the total amount of insulin used within 24 hours were significantly smaller than those in the control group (both P<0.05). The amount of calories administered to the observation group when reaching the target blood glucose level was significantly higher than that of the control group ( P=0.002). The number of blood glucose measurements within 24 hours after insulin initiation in the observation group was significantly larger than that in the control group ( P=0.042), but there was no statistically significant difference in the total number of monitoring during EICU stay ( P=0.561). The incidence rates of hypoglycemia and hypokalemia and the amount of potassium supplemented for hypokalemia in the observation group were significantly lower than those in the control group (all P<0.05). There was no statistically significant difference in the length of EICU stay and the incidence of nosocomial infection between the two groups (both P>0.05). Conclusions:Process management for CPII in critically ill patients promotes rapid glycemic control during enteral nutrition (EN), reduces hypoglycemia, hypokalemia, and nosocomial infections, and improves overall blood glucose stability. It is vital for controlling stress hyperglycemia during EN in critical illness, with excellent safety.
