1. Outcomes of a cardiothoracic intensive care web-based online intravenous insulin infusion calculator study at a Medical University Hospital
- Author
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Kathie L. Hermayer, Diane E. Neal, Michael G. Irving, John M. Kratz, Timothy V. Hushion, Pamela C. Arnold, Frank B. Kerr, Martha R. Stroud, and Lisa Kozlowski
- Subjects
Blood Glucose ,Male ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,law.invention ,Hospitals, University ,Endocrinology ,law ,Intensive care ,Diabetes mellitus ,Intravenous insulin ,medicine ,Web application ,Humans ,Hypoglycemic Agents ,Insulin ,Drug Dosage Calculations ,Coronary Artery Bypass ,Intensive care medicine ,Infusions, Intravenous ,Aged ,Internet ,business.industry ,Coronary Care Units ,Middle Aged ,University hospital ,medicine.disease ,Drug Dosage Calculation ,Medical Laboratory Technology ,Calculator ,Female ,business ,Algorithms - Abstract
The purpose of this study was to examine whether a web-based, on-line intravenous insulin (IVI) infusion calculator (IVIIC) program for the delivery of IVI therapy in coronary artery bypass graft (CABG) patients was superior to a prior IVI protocol used in the cardiothoracic intensive care unit at our institution.The study included 97 CABG patients studied from October 2004 to February 2005 pre-protocol (type 2 diabetes) and October 2005 to February 2006 post-protocol (with or without type 2 diabetes). The IVIIC was programmed to resemble an algorithm whereby any patient with type 2 diabetes or a blood glucose (BG) greater than 120 mg/dL was started on IVI with an insulin sensitivity factor, a multiplier of 0.03. The calculator used the following mathematical formula: rate of insulin infusion/hour = (current BG - 60 mg/dL) x 0.03.Pre- and post-protocol groups for patients with type 2 diabetes were similar in all demographics measured, including initial age, mean age, percentage female, and percentage African-American. Significant differences were observed between pre- and post-protocol groups in mean BG recorded over a 48-h period (P0.0001), percentage not at target within 48 h (P0.0001), mean hours to first BG between 80 to 120 mg/dL (P0.0001), mean hours to target (three consecutive BGs 80-120 mg/dL) (P0.0001), and hyperglycemic index (P0.0001). The incidence of hypoglycemia (percentage BG70 mg/dL) was not significantly increased in the post-protocol groups (P = 0.2581).We conclude that the IVIIC is a safe nurse-driven protocol with excellent BG outcomes.
- Published
- 2007