Yale insulin protocol infusion in sepsis patients

Abstract

Introduction: Actually tight glycemic control is a major concern in critical care. Hyperglycemia occurs frequently in critically ill diabetic and nondiabetic patients and strict control of blood glucose has been considered ideal behavior with the use of continuous intravenous insulin generalizing in intensive care units in worldwide. Hypothesis: This study aimed to evaluate the effectiveness and safety of Yale insulin therapy protocol, used to maintain blood glucose between 100 and 150 mg/dL, in critically ill patients admitted to general intensive care unit. Method(s): Retrospective, before-after cohort study. Selected end-points were mean bloodglucose levels, time-to-reach target range of 100-150 mg/dL, andper-cent of blood glucose in target range and hypoglyce-mia incidence. Result(s): Were studied 78 patients: 42 in control group (CG) and 36 in protocol group (PG). Bedside bloodglucose was measured 3755 times for a mean value of 134.1 +/- 15.4 mg/dL in the PG versus 1730 ti-mes for a mean value of 172.7 - 33.6 mg/dL in the CG. Blood glucose values were in the target range 63% and 37% of the times, respectively for PG and CG groups (p<0.001). The median time to reach glucose target range was 8 hours (range 5 -17 hours) for PG and 53 hours (range 23-218 hours) for CG (p<0.001). Incidence of severe hy-poglycemia reaches a difference statistically signifi- cant: 1 patient in PG versus 4 patients in CG (p<0.01). All patients reached the target in 72 hours of insulin infusion in the PG while only 29 patients in CG reached. Conclusion(s): This study showed that the Yale protocol was effective and safe for handling the continuous intravenous insulin therapy, aimed at strict glycemic control for medical and surgical critical ill patients admitted to the intensive care unit.