The impact of a normoglycemic management protocol on clinical outcomes in the trauma intensive care unit

Bryan Collier, Jose Diaz, Rachel Forbes, John Morris, Addison May, Jeffrey Guy, Asli Ozdas, William Dupont, Richard Miller, Gordon Lee Jensen

Research output: Contribution to journalArticle

61 Citations (Scopus)

Abstract

Background: The purpose of this study was to determine if protocol-driven normoglycemic management in trauma patients affected glucose control, ventilator-associated pneumonia, surgical-site infection, and inpatient mortality. Methods: A prospective, consecutive-series, historically controlled study design evaluated protocol-driven normoglycemic management among trauma patients at Vanderbilt University Medical Center. Those mechanically ventilated ≥24 hours and ≥15 years of age were included. A glycemic-control protocol required insulin infusion therapy for glucose >110 mg/dL. Control patients included those who met criteria, were admitted the year preceding protocol implementation, and had hyperglycemia treated at the physician's discretion. Results: Eight hundred eighteen patients met study criteria; 383 were managed without protocol; 435 underwent protocol. The protocol group had lower glucose levels 7 of 14 days measured. After admission, both groups had mean daily glucose levels <150 mg/dL. No difference in pneumonia (31.6% vs 34.5%; p = .413), surgical infection (5.0% vs 5.7%; p = .645) or mortality (12.3% vs 13.1%; p = .722) occurred between groups. If one episode of blood glucose level was ≥150 mg/dL (n = 638; 78.0%), outcomes were worse: higher daily glucose levels for 14 days after admission (p < .001), pneumonia rates (35.9% vs 23.3%; p = .002), and mortality (14.6% vs 6.1%; p = .002). One or more days of glucose ≥150 mg/dL had a 2- to 3-fold increase in the odds of death. Protocol use in these patients was not associated with outcome improvement. Conclusions: Protocol-driven management decreased glucose levels 7 of 14 days after admission without outcome change. One or more glucose levels ≥150 mg/dL were associated with worse outcome.

Original languageEnglish (US)
Pages (from-to)353-358
Number of pages6
JournalJournal of Parenteral and Enteral Nutrition
Volume29
Issue number5
DOIs
StatePublished - Sep 1 2005

Fingerprint

Clinical Protocols
Intensive Care Units
Glucose
Wounds and Injuries
Mortality
Pneumonia
Surgical Wound Infection
Ventilator-Associated Pneumonia
Hyperglycemia
Blood Glucose
Inpatients
Insulin
Physicians
Infection

All Science Journal Classification (ASJC) codes

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

Cite this

Collier, Bryan ; Diaz, Jose ; Forbes, Rachel ; Morris, John ; May, Addison ; Guy, Jeffrey ; Ozdas, Asli ; Dupont, William ; Miller, Richard ; Jensen, Gordon Lee. / The impact of a normoglycemic management protocol on clinical outcomes in the trauma intensive care unit. In: Journal of Parenteral and Enteral Nutrition. 2005 ; Vol. 29, No. 5. pp. 353-358.
@article{d966979ad1a042f7a167837d6e9f700d,
title = "The impact of a normoglycemic management protocol on clinical outcomes in the trauma intensive care unit",
abstract = "Background: The purpose of this study was to determine if protocol-driven normoglycemic management in trauma patients affected glucose control, ventilator-associated pneumonia, surgical-site infection, and inpatient mortality. Methods: A prospective, consecutive-series, historically controlled study design evaluated protocol-driven normoglycemic management among trauma patients at Vanderbilt University Medical Center. Those mechanically ventilated ≥24 hours and ≥15 years of age were included. A glycemic-control protocol required insulin infusion therapy for glucose >110 mg/dL. Control patients included those who met criteria, were admitted the year preceding protocol implementation, and had hyperglycemia treated at the physician's discretion. Results: Eight hundred eighteen patients met study criteria; 383 were managed without protocol; 435 underwent protocol. The protocol group had lower glucose levels 7 of 14 days measured. After admission, both groups had mean daily glucose levels <150 mg/dL. No difference in pneumonia (31.6{\%} vs 34.5{\%}; p = .413), surgical infection (5.0{\%} vs 5.7{\%}; p = .645) or mortality (12.3{\%} vs 13.1{\%}; p = .722) occurred between groups. If one episode of blood glucose level was ≥150 mg/dL (n = 638; 78.0{\%}), outcomes were worse: higher daily glucose levels for 14 days after admission (p < .001), pneumonia rates (35.9{\%} vs 23.3{\%}; p = .002), and mortality (14.6{\%} vs 6.1{\%}; p = .002). One or more days of glucose ≥150 mg/dL had a 2- to 3-fold increase in the odds of death. Protocol use in these patients was not associated with outcome improvement. Conclusions: Protocol-driven management decreased glucose levels 7 of 14 days after admission without outcome change. One or more glucose levels ≥150 mg/dL were associated with worse outcome.",
author = "Bryan Collier and Jose Diaz and Rachel Forbes and John Morris and Addison May and Jeffrey Guy and Asli Ozdas and William Dupont and Richard Miller and Jensen, {Gordon Lee}",
year = "2005",
month = "9",
day = "1",
doi = "10.1177/0148607105029005353",
language = "English (US)",
volume = "29",
pages = "353--358",
journal = "Journal of Parenteral and Enteral Nutrition",
issn = "0148-6071",
publisher = "SAGE Publications Inc.",
number = "5",

}

Collier, B, Diaz, J, Forbes, R, Morris, J, May, A, Guy, J, Ozdas, A, Dupont, W, Miller, R & Jensen, GL 2005, 'The impact of a normoglycemic management protocol on clinical outcomes in the trauma intensive care unit', Journal of Parenteral and Enteral Nutrition, vol. 29, no. 5, pp. 353-358. https://doi.org/10.1177/0148607105029005353

The impact of a normoglycemic management protocol on clinical outcomes in the trauma intensive care unit. / Collier, Bryan; Diaz, Jose; Forbes, Rachel; Morris, John; May, Addison; Guy, Jeffrey; Ozdas, Asli; Dupont, William; Miller, Richard; Jensen, Gordon Lee.

In: Journal of Parenteral and Enteral Nutrition, Vol. 29, No. 5, 01.09.2005, p. 353-358.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The impact of a normoglycemic management protocol on clinical outcomes in the trauma intensive care unit

AU - Collier, Bryan

AU - Diaz, Jose

AU - Forbes, Rachel

AU - Morris, John

AU - May, Addison

AU - Guy, Jeffrey

AU - Ozdas, Asli

AU - Dupont, William

AU - Miller, Richard

AU - Jensen, Gordon Lee

PY - 2005/9/1

Y1 - 2005/9/1

N2 - Background: The purpose of this study was to determine if protocol-driven normoglycemic management in trauma patients affected glucose control, ventilator-associated pneumonia, surgical-site infection, and inpatient mortality. Methods: A prospective, consecutive-series, historically controlled study design evaluated protocol-driven normoglycemic management among trauma patients at Vanderbilt University Medical Center. Those mechanically ventilated ≥24 hours and ≥15 years of age were included. A glycemic-control protocol required insulin infusion therapy for glucose >110 mg/dL. Control patients included those who met criteria, were admitted the year preceding protocol implementation, and had hyperglycemia treated at the physician's discretion. Results: Eight hundred eighteen patients met study criteria; 383 were managed without protocol; 435 underwent protocol. The protocol group had lower glucose levels 7 of 14 days measured. After admission, both groups had mean daily glucose levels <150 mg/dL. No difference in pneumonia (31.6% vs 34.5%; p = .413), surgical infection (5.0% vs 5.7%; p = .645) or mortality (12.3% vs 13.1%; p = .722) occurred between groups. If one episode of blood glucose level was ≥150 mg/dL (n = 638; 78.0%), outcomes were worse: higher daily glucose levels for 14 days after admission (p < .001), pneumonia rates (35.9% vs 23.3%; p = .002), and mortality (14.6% vs 6.1%; p = .002). One or more days of glucose ≥150 mg/dL had a 2- to 3-fold increase in the odds of death. Protocol use in these patients was not associated with outcome improvement. Conclusions: Protocol-driven management decreased glucose levels 7 of 14 days after admission without outcome change. One or more glucose levels ≥150 mg/dL were associated with worse outcome.

AB - Background: The purpose of this study was to determine if protocol-driven normoglycemic management in trauma patients affected glucose control, ventilator-associated pneumonia, surgical-site infection, and inpatient mortality. Methods: A prospective, consecutive-series, historically controlled study design evaluated protocol-driven normoglycemic management among trauma patients at Vanderbilt University Medical Center. Those mechanically ventilated ≥24 hours and ≥15 years of age were included. A glycemic-control protocol required insulin infusion therapy for glucose >110 mg/dL. Control patients included those who met criteria, were admitted the year preceding protocol implementation, and had hyperglycemia treated at the physician's discretion. Results: Eight hundred eighteen patients met study criteria; 383 were managed without protocol; 435 underwent protocol. The protocol group had lower glucose levels 7 of 14 days measured. After admission, both groups had mean daily glucose levels <150 mg/dL. No difference in pneumonia (31.6% vs 34.5%; p = .413), surgical infection (5.0% vs 5.7%; p = .645) or mortality (12.3% vs 13.1%; p = .722) occurred between groups. If one episode of blood glucose level was ≥150 mg/dL (n = 638; 78.0%), outcomes were worse: higher daily glucose levels for 14 days after admission (p < .001), pneumonia rates (35.9% vs 23.3%; p = .002), and mortality (14.6% vs 6.1%; p = .002). One or more days of glucose ≥150 mg/dL had a 2- to 3-fold increase in the odds of death. Protocol use in these patients was not associated with outcome improvement. Conclusions: Protocol-driven management decreased glucose levels 7 of 14 days after admission without outcome change. One or more glucose levels ≥150 mg/dL were associated with worse outcome.

UR - http://www.scopus.com/inward/record.url?scp=28544435652&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=28544435652&partnerID=8YFLogxK

U2 - 10.1177/0148607105029005353

DO - 10.1177/0148607105029005353

M3 - Article

C2 - 16107598

AN - SCOPUS:28544435652

VL - 29

SP - 353

EP - 358

JO - Journal of Parenteral and Enteral Nutrition

JF - Journal of Parenteral and Enteral Nutrition

SN - 0148-6071

IS - 5

ER -