Computerized insulin infusion programs are safe and effective in the burn intensive care unit

Area of Science:

• Intensive Care Medicine
• Metabolic Control
• Burn Patient Management

Background:

• Effective glucose control is crucial for surgical intensive care unit (ICU) patient outcomes.
• Intensive insulin therapy shows promise in reducing complications, but traditional protocols risk severe hypoglycemia.
• Existing computer-guided glucose control programs report low hypoglycemia rates.

Purpose of the Study:

• To evaluate the efficacy and safety of an institutional computer-based intensive insulin protocol in burn patients.
• To determine if this protocol can be used effectively without increasing the risk of severe hypoglycemia.

Main Methods:

• A retrospective analysis of 31 burn ICU patients treated with a computer-based intravenous insulin protocol from January to December 2008.
• Blood glucose (BG) levels were monitored hourly, with adjustments made per the computer protocol for BG >200 mg/dl.
• Data on BG measurements, target range adherence, and hypoglycemic events were collected and analyzed.

Main Results:

• Out of 12,699 measurements, only 0.07% (eight measurements) were below 50 mg/dl, indicating a very low rate of severe hypoglycemia.
• Seventy-six percent of BG values fell within the target range of 90 to 150 mg/dl.
• Severe hyperglycemia (BG >300 mg/dl) occurred in only 0.2% of measurements, with no associated adverse events.

Conclusions:

• The adopted computer-based insulin protocol is highly effective for glucose control in burn patients.
• This protocol provides safe and reliable glycemic management, with significantly lower rates of severe hypoglycemia than traditional methods.
• The findings support the use of this institutional computer protocol for managing burn patients in the ICU.