Evaluation of Effectiveness and Safety of an ICU Insulin Infusion Protocol

Abstract

Objective. To evaluate the efficacy, safety, and clinical outcomes of, and protocol deviations with the use of the Modified Yale Insulin Infusion Protocol (IIP) compared to usual/standard care in the local setting. Methods. Chart review of patients admitted in two ICUs over a 2-year period was done. Patients eligible for intensive glycemic control were identified. Efficacy, safety and clinical outcomes were compared between the Modified Yale IIP and usual/standard care. Charts managed with the IIP were appraised for protocol deviations. Results. Eighty-one patients met the inclusion criteria and 34.6% used the IIP. The IIP group achieved a lower mean blood glucose (185.1 vs 212.1 mg/dl, p<0.05). They reached normoglycemia (5 vs 12 hours, p<0.05) and target range of 140-180 mg/dl (8.3 vs 18.3 hours, p<0.05) earlier. Hypoglycemia was rare (median 0%) in both groups. No difference in mortality or morbidity was seen. Hospital (13.9 vs 8.1 days, p<0.05) and ICU stay (5.5 vs 3.0 days, p<0.05) were longer in the IIP group. A mean of 11 deviations per patient occurred, the majority of which were errors on insulin dose administered (66.6%). Conclusion. The Modified Yale IIP is efficaceous, safe and yielded better glycemic profiles than usual care. Majority of protocol deviations were on the insulin dose administered