scholarly journals Continuous Infusion of Subcutaneous Compared to Intravenous Insulin for Tight Glycaemic Control in Medical Intensive Care Unit Patients

2008 ◽  
Vol 36 (4) ◽  
pp. 520-527 ◽  
Author(s):  
H. A. Bodur ◽  
F. Saygili ◽  
S. Saygili ◽  
L. H. Doganay ◽  
S. Yesil
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Glycaemic Control ◽  
Continuous Infusion ◽  
Medical Intensive Care Unit ◽  
Tight Glycaemic Control ◽  
Intravenous Insulin ◽  
Medical Intensive Care

Safety and Effectiveness of Sedation With Adjunctive Ketamine Versus Nonketamine Sedation in the Medical Intensive Care Unit

2020 ◽  
pp. 089719002092593
Author(s):  
Melanie Jaeger ◽  
Rebecca L. Attridge ◽  
Luke A. Neff ◽  
G. Christina Gutierrez
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Continuous Infusion ◽  
Primary Outcome ◽  
Medical Intensive Care Unit ◽  
Aspartate Receptor ◽  
Number Of Patients ◽  
Medical Intensive Care ◽  
Baseline Characteristics ◽  
New Antipsychotics

Background: Ketamine, an N-methyl-d-aspartate receptor antagonist with sedative and analgesic properties, is becoming more popular as an adjunctive sedative in the critically ill patients. Methods: We conducted a single center, retrospective cohort study of patients admitted to the medical intensive care unit (MICU) between 2013 and 2018. Patients who received continuous infusion ketamine or nonketamine sedatives (NKS) including dexmedetomidine, fentanyl, midazolam, or propofol were identified. The primary outcome was percentage of Richmond Agitation-Sedation Scale (RASS) scores at goal in patients receiving ketamine as adjunct to NKS compared to those on NKS alone. Results: A total of 172 patients were included (n = 86 ketamine, n = 86 NKS). Baseline characteristics were similar with the exception of antipsychotic use, which was higher in the ketamine group ( P = .008). Percentage of RASS scores at goal was not different between groups (78.7% vs 81.4%, P = .29). Fewer patients in the ketamine group received continuous infusion fentanyl (76.7% vs 94.2%, P = .002). Patients on adjunctive ketamine required fewer days of intermittent benzodiazepines (0 [0-1] vs 1 [1-2], P < .0001). Patients receiving ketamine required less norepinephrine, receiving a median of 6.32 mg (2.4-20) versus 11.7 mg (5.2-45.2; P = .03). There was no difference in receipt of new antipsychotics or occurrence of arrhythmias. Conclusion: Addition of ketamine did not increase the percentage of RASS scores at goal versus NKS but was well tolerated. Ketamine was associated with reductions in norepinephrine requirements, days of intermittent benzodiazepine administration, and number of patients receiving continuous infusion fentanyl. Continuous infusion ketamine appears safe and effective for sedation in the MICU.

Nurse-Led Implementation of a Safe and Effective Intravenous Insulin Protocol in a Medical Intensive Care Unit

2011 ◽  
Vol 31 (6) ◽  
pp. 27-35 ◽  
Author(s):  
Rabia Khalaila ◽  
Eugene Libersky ◽  
Dina Catz ◽  
Elina Pomerantsev ◽  
Abed Bayya ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Glucose ◽  
Medical Intensive Care Unit ◽  
Control Group ◽  
Glucose Levels ◽  
Intravenous Insulin ◽  
Blood Glucose Levels ◽  
Protocol Group ◽  
Medical Intensive Care

BackgroundRecent evidence has linked tight glucose control to worsened clinical outcomes among adults in intensive care units.ObjectiveTo evaluate the effectiveness and safety of a nurse-led intravenous insulin protocol designed to achieve conservative blood glucose control in patients in a medical intensive care unit.MethodsA nurse-led intravenous insulin protocol was developed, targeting blood glucose levels at 110 to 149 mg/dL. Hypoglycemia was defined as a blood glucose level less than 70 mg/dL. Patients admitted to the medical intensive care unit who required an insulin infusion were enrolled in the study. Blood glucose levels in those patients were compared with levels in 153 historical control patients admitted to the unit in the 12 months before the protocol was implemented who required an insulin infusion.ResultsNinety-six patients were enrolled and treated with the protocol. The protocol and control groups had similar characteristics at baseline. More measurements in the protocol group than in the control group (46.3% vs 36.1%, P&lt;.001) were within the target glucose range (110–149 mg/dL). Hyperglycemia (blood glucose ≥200 mg/dL) occurred less often in the protocol group than in the control group (14.8% vs 20.1%, P=.003). Hypoglycemic events (blood glucose &lt;70 mg/dL) also occurred less often in the protocol group (0.07% vs 0.83%, P&lt;.001).ConclusionsImplementation of a nurse-led, conservative intravenous insulin protocol in the medical intensive care unit is effective and safe and markedly reduces the rate of hypoglycemia.

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