학술논문
Insulin therapy and blood glucose management in critically ill patients: a 1-day cross-sectional observational study in 69 French intensive care units
Document Type
article
Author
Maxime Desgrouas; Julien Demiselle; Laure Stiel; Vincent Brunot; Rémy Marnai; Sacha Sarfati; Maud Fiancette; Fabien Lambiotte; Arnaud W. Thille; Maxime Leloup; Sébastien Clerc; Pascal Beuret; Anne-Astrid Bourion; Johan Daum; Rémi Malhomme; Ramin Ravan; Bertrand Sauneuf; Jean-Philippe Rigaud; Pierre-François Dequin; Thierry Boulain
Source
Annals of Intensive Care, Vol 13, Iss 1, Pp 1-13 (2023)
Subject
Language
English
ISSN
2110-5820
Abstract
Abstract Background Hyperglycaemia is common in critically ill patients, but blood glucose and insulin management may differ widely among intensive care units (ICUs). We aimed to describe insulin use practices and the resulting glycaemic control in French ICUs. We conducted a multicentre 1-day observational study on November 23, 2021, in 69 French ICUs. Adult patients hospitalized for an acute organ failure, severe infection or post-operative care were included. Data were recorded from midnight to 11:59 p.m. the day of the study by 4-h periods. Results Two ICUs declared to have no insulin protocol. There was a wide disparity in blood glucose targets between ICUs with 35 different target ranges recorded. In 893 included patients we collected 4823 blood glucose values whose distribution varied significantly across ICUs (P 1.8 g/L) in 402 (45.0%) patients, 35 hypoglycaemias (≤ 0.7 g/L) in 26 (2.9%) patients, and one instance of severe hypoglycaemia (≤ 0.4 g/L). Four hundred eight (45.7%) patients received either IV insulin (255 [62.5%]), subcutaneous (SC) insulin (126 [30.9%]), or both (27 [6.6%]). Among patients under protocolized intravenous (IV) insulin, 767/1681 (45.6%) of glycaemias were above the target range. Among patients receiving insulin, short- and long-acting SC insulin use were associated with higher counts of hyperglycaemias as assessed by multivariable negative binomial regression adjusted for the propensity to receive SC insulin: incidence rate ratio of 3.45 (95% confidence interval [CI] 2.97–4.00) (P