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Moderate glycemic control safe in critically ill adult burn patients: A 15 year cohort study

Patricia Stoecklin1, Frederik Delodder1, Olivier Pantet1

  • 1Service of Intensive Care Medicine & Burns, University Hospital (CHUV), 1011 Lausanne, Switzerland.

Burns : Journal of the International Society for Burn Injuries
|December 23, 2015
PubMed

Insights

Implementing a standardized intensive care unit (ICU) glucose control protocol in major burn patients improved glycemic control and reduced glucose variability. Moderate glucose management proved safe, significantly lowering hypoglycemia incidence while maintaining reduced hyperglycemia.

Area of Science:

  • Intensive Care Medicine
  • Burn Management
  • Metabolic Regulation

Background:

  • Hyperglycemia is a common complication in major burn patients, impacting outcomes.
  • Effective glucose control is crucial for managing metabolic alterations in severe burns.
  • Evaluating glucose control protocols in prolonged ICU stays for burn patients is essential.

Purpose of the Study:

  • To assess the safety and efficacy of general ICU glucose control protocols in major burn patients.
  • To analyze the impact of standardized protocols on glycemic control and variability.
  • To compare different phases of protocol implementation.

Main Methods:

  • Retrospective analysis of 229 adult burn patients over 15 years.
  • Inclusion criteria: adult burn patients with prolonged ICU treatment.
  • Exclusion criteria: death or length of stay <10 days, age <16 years.
  • Analysis of demographic, burn severity, infection, ICU stay, and outcome variables.
  • Metabolic variables included energy, carbohydrate, and insulin delivery, blood glucose, and CRP.
  • Data analyzed across four periods: pre-protocol, tight doctor-driven, tight nurse-driven, and moderate nurse-driven protocols.

Main Results:

  • The standardized protocol increased normoglycemic values from 34.7% to 65.9%.
  • Hypoglycemic events significantly reduced, with no extreme hypoglycemia in the final period.
  • Severe hyperglycemia persisted but decreased to 9.25% in the moderate control period.
  • Energy and glucose delivery decreased, while infectious complications increased in later periods.

Conclusions:

  • Standardized ICU glucose control protocols enhance glycemic management in adult burn patients.
  • Moderate glycemic control is safe, effectively reducing hypoglycemia incidence.
  • Protocols improve glucose variability, though persistent hyperglycemia requires continued attention.
Abstract

Keywords:
ComplicationCritical illnessHypoglycemiaInsulin utilisationNutrition

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