Glucose control has repeatedly been shown to influence favorable outcomes in the
surgical intensive care unit (ICU). Intensive
insulin therapy has recently been associated with reduced
infections complications in
burn patients. However, traditional protocols are associated with rates of severe
hypoglycemia as high as 19%. Two commercial computer
glucose control programs have reported rates of severe
hypoglycemia (
glucose <50 mg/dl) of 0.6 and 0.4%. Recently, the authors'
burn ICU adopted an intensive
insulin computer-based protocol created at their institution and already successfully in use in their surgical ICU. The authors hypothesized that their protocol can be used effectively in the
burn patient population without an increase risk of severe
hypoglycemia. All patients admitted to the
burn ICU have
blood glucose (BG) values checked routinely. With two consecutive hyperglycemic values >200 mg/dl, patients are placed on a computer-based protocol intravenous
insulin drip. Once initiated, BGs are tested hourly with adjustments made according to the computer protocol. Values recorded from January to December 2008 were abstracted from the database and analyzed. Thirty-one patients were treated using the computer
glucose control protocol and 12,699 measurements were performed. There were eight measurements <50 mg/dl (0.07%). Seventy-six percent of values were within the target range of 90 to 150 mg/dl. Few patients had severe
hyperglycemia with BG >300 mg/dl (0.2%). There were no adverse events associated with the
hypoglycemic episode. The computer-based protocol is more effective than those previously used at the institution and provides safe, reliable results in the
burn patients.