We’re sorry, something doesn't seem to be working properly.
Please try refreshing the page. If that doesn't work, please contact us so we can address the problem.
Tight glucose control managed by ICU nurses induces extremely low rates of hypoglycemia
© Delodder et al. 2011
- Published: 1 March 2011
- Blood Glucose Level
- Blood Glucose Measurement
- Internal Audit
Recent studies failed to confirm survival benefit of tight glucose control (TGC). Moreover, they reported high rates (6 to 18%) of hypoglycemia (<2.5 mmol/l) associated with significant mortality. The protocols used for TGC may be difficult to apply. The reasons for blood glucose level variations are complex and TGC requires in-depth individualized knowledge of the patient condition. Frequent blood glucose measurements are mandatory for continue adaptations of insulin and glucose administration. We report the evolution of blood glucose level through various phases of TGC implementation, which become progressively completely nurse driven.
An internal audit performed in 2002, in five of our 32 adult ICU beds, showed 26% of hyperglycemia (>10 mmol). TGC was introduced in 2003 for all patients in the ICU and supported by detailed guidelines for bedside glucose control. TGC was progressively transferred from physicians to nurses since 2007. Nurses are specifically trained to adapt infusion rates of glucose (nutrition), insulin according to medically predefined targets (4.5 to 6.0; 6.0 to 8.0; >10 mmol/l). Arterial and venous glucose levels are determined by the central laboratory or by blood gas analyzers in the ICU. Glycemia (n = 750,178) was extracted from our electronic clinical information system (Metavision®) and analyzed with STATA.
Implementation and progressive transfer of tight glucose control to ICU nurses in a large mixed adult ICU significantly decreased the proportion of hyperglycemia to less than 10%, and maintained extremely low rates of hypoglycemia (<0.1%).
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.