Morbidity reduction in critically ill trauma patients through use of a computerized insulin infusion protocol: A preliminary study

Eric A. Toschlog, Christopher Newton, Nichole Allen, Mark A. Newell, Claudia E. Goettler, Paul J. Schenarts, Michael R. Bard, Scott G. Sagraves, Michael F. Rotondo

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

BACKGROUND: Recent data have demonstrated that intensive glycemic control during critical illness improves outcome. The purpose of our study was to evaluate the effect of a computerized hospital insulin protocol (CHIP) on glycemic control and outcome in critically ill trauma patients. METHODS: Two, 6-month cohorts were compared, one 6 months prior to chip implementation (pre-CHIP) and one from the 6-month period after implementation (post-CHIP), using finger stick blood glucose values and demographic, injury severity, and outcome variables for adult patients with intensive care unit length of stay (LOS) ≥72 hours. Infectious morbidity was based upon the National Trauma Registry of the American College of Surgeons definitions. Differences between cohorts were assessed using Student's t test and Fisher's exact test for continuous and categorical variables. RESULTS: The 129 pre- and 128 post-CHIP patients were well matched for demographics and injury severity. Significant reductions in mean finger stick blood glucose, rates of ventilator- associated pneumonia, central venous line infection, total infections, and all LOS categories were demonstrated in the post-CHIP cohort. However, mortality was significantly higher in the post-CHIP cohort. CONCLUSION: This preliminary study demonstrates significant morbidity and LOS reductions with the use of a CHIP, but significantly increased mortality. Further prospective studies are necessary to assess the effects of intensive glycemic control on outcome after injury, particularly in sub populations who might be adversely affected.

Original languageEnglish (US)
Pages (from-to)1370-1375
Number of pages6
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume62
Issue number6
DOIs
StatePublished - Jun 1 2007

Fingerprint

Critical Illness
Insulin
Morbidity
Wounds and Injuries
Length of Stay
Fingers
Blood Glucose
Demography
Ventilator-Associated Pneumonia
Mortality
Infection
Intensive Care Units
Registries
Prospective Studies
Students
Population

Keywords

  • Computerized
  • Glycemic control
  • Insulin
  • Protocol
  • Trauma

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Morbidity reduction in critically ill trauma patients through use of a computerized insulin infusion protocol : A preliminary study. / Toschlog, Eric A.; Newton, Christopher; Allen, Nichole; Newell, Mark A.; Goettler, Claudia E.; Schenarts, Paul J.; Bard, Michael R.; Sagraves, Scott G.; Rotondo, Michael F.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 62, No. 6, 01.06.2007, p. 1370-1375.

Research output: Contribution to journalArticle

Toschlog, Eric A. ; Newton, Christopher ; Allen, Nichole ; Newell, Mark A. ; Goettler, Claudia E. ; Schenarts, Paul J. ; Bard, Michael R. ; Sagraves, Scott G. ; Rotondo, Michael F. / Morbidity reduction in critically ill trauma patients through use of a computerized insulin infusion protocol : A preliminary study. In: Journal of Trauma - Injury, Infection and Critical Care. 2007 ; Vol. 62, No. 6. pp. 1370-1375.
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