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Crit Care Med. 2008 Jun;36(6):1787-95. doi: 10.1097/CCM.0b013e3181743a5a.

A replicable method for blood glucose control in critically Ill patients.

Author information

1
Pulmonary Division, Department of Medicine, LDS Hospital and the University of Utah School of Medicine, Salt Lake City, UT, USA. ldamorri@ihc.com

Abstract

CONTEXT:

To ensure interpretability and replicability of clinical experiments, methods must be adequately explicit and should elicit the same decision from different clinicians who comply with the study protocol.

OBJECTIVE:

The objective of this study was to determine whether clinician compliance with protocol recommendations exceeds 90%.

DESIGN:

We developed an adequately explicit computerized protocol (eProtocol-insulin) for managing critically ill adult patient blood glucose. We monitored clinician compliance with eProtocol-insulin recommendations in four intensive care units in four hospitals and compared blood glucose distributions with those of a simple clinical guideline at one hospital and a paper-based protocol at another. All protocols and the guideline used intravenous insulin and 80 to 110 mg/dL (4.4-6.1 mmol/L) blood glucose targets.

SETTING:

The setting for this study was four academic hospital intensive care units.

PATIENTS:

This study included critically ill adults requiring intravenous insulin.

INTERVENTION:

Intervention used in this study was a bedside computerized protocol for managing blood glucose.

MAIN OUTCOME MEASURE:

The main outcome measure was clinician compliance with eProtocol-insulin recommendations.

RESULTS:

The number of patients was 31 to 458 and the number of blood glucose measurements was 2,226 to 19,925 among the four intensive care units. Clinician compliance with eProtocol-insulin recommendations was 91% to 98%. Blood glucose distributions were similar in the four hospitals (generalized linear model p = .18). Compared with the simple guideline, eProtocol-insulin glucose measurements within target increased from 21% to 39%, and mean blood glucose decreased from 142 to 115 mg/dL (generalized linear model p < .001). Compared with the paper-based protocol, eProtocol-insulin glucose measurements within target increased from 28% to 42%, and mean blood glucose decreased from 134 to 116 mg/dL (generalized linear model p = .001).

CONCLUSIONS:

The 91% to 98% clinician compliance indicates eProtocol-insulin is an exportable instrument that can establish a replicable experimental method for clinical trials of blood glucose management in critically ill adults. Control of blood glucose was better with eProtocol-insulin than with a simple clinical guideline or a paper-based protocol.

PMID:
18520641
DOI:
10.1097/CCM.0b013e3181743a5a
[Indexed for MEDLINE]

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