[Implementation and evaluation of a protocol for continuous insulin perfusion in critical patients]

To analyze the efficacy and safety of a protocol for the continuous infusion of insulin to maintain blood glucose levels between 100 and 140 mg/dl, evaluating the results by a method that takes all of the hours of treatment into consideration.

Prospective observational study over a two-month period and follow up until the end of insulin perfusion.

Twenty three-bed polyvalent ICU.

Fifty consecutive patients >18 years of age with 2 episodes of glycemia >140 mg/dl separated by 4-6 hours. Patients on an oral diet were excluded.

The perfusion rate and the frequency of glycemia monitoring were set according to the nursing staff's protocol.

Days of insulin perfusion and number and value of the blood glucose measurements taken. Episodes of hypoglycemia, mean blood glucose level, the percentage of hyperglycemia episodes, and the number of hours that the patient's blood glucose was in each range.

The mean duration of treatment was 15.6 days (SD 12). A total of 17,768 hours and 8,111 blood glucose measurements were collected. 55.5% of the blood glucose measurements were between 100-140 mg/dl, and this represents 63.9% of the hours. The mean blood glucose level was 133 mg/dl. Only 2 episodes of severe hypoglycemia (<45 mg/dl) occurred.

The protocol was safe and enabled adequate control of blood glucose levels. The analysis of all of the hours of treatment might provide more data than a simple study of the percentages of blood glucose measurements within the normal range and the mean blood glucose level.