Morbidity reduction in critically ill trauma patients through use of a computerized insulin infusion protocol: A preliminary study

Eric A. Toschlog, Christopher Newton, Nichole Allen, Mark A. Newell, Claudia E. Goettler, Paul J. Schenarts, Michael R. Bard, Scott G. Sagraves, Michael F. Rotondo

Research output: Contribution to journalArticlepeer-review

30 Scopus citations

Abstract

BACKGROUND: Recent data have demonstrated that intensive glycemic control during critical illness improves outcome. The purpose of our study was to evaluate the effect of a computerized hospital insulin protocol (CHIP) on glycemic control and outcome in critically ill trauma patients. METHODS: Two, 6-month cohorts were compared, one 6 months prior to chip implementation (pre-CHIP) and one from the 6-month period after implementation (post-CHIP), using finger stick blood glucose values and demographic, injury severity, and outcome variables for adult patients with intensive care unit length of stay (LOS) ≥72 hours. Infectious morbidity was based upon the National Trauma Registry of the American College of Surgeons definitions. Differences between cohorts were assessed using Student's t test and Fisher's exact test for continuous and categorical variables. RESULTS: The 129 pre- and 128 post-CHIP patients were well matched for demographics and injury severity. Significant reductions in mean finger stick blood glucose, rates of ventilator- associated pneumonia, central venous line infection, total infections, and all LOS categories were demonstrated in the post-CHIP cohort. However, mortality was significantly higher in the post-CHIP cohort. CONCLUSION: This preliminary study demonstrates significant morbidity and LOS reductions with the use of a CHIP, but significantly increased mortality. Further prospective studies are necessary to assess the effects of intensive glycemic control on outcome after injury, particularly in sub populations who might be adversely affected.

Original languageEnglish (US)
Pages (from-to)1370-1375
Number of pages6
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume62
Issue number6
DOIs
StatePublished - Jun 2007

Keywords

  • Computerized
  • Glycemic control
  • Insulin
  • Protocol
  • Trauma

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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