Evaluación de un protocolo de perfusión continua de insulina en enfermos críticos / Implementation and evaluation of a protocol for continuous insulin perfusion in critical patients

Objetivo. Analizar la eficacia y la seguridad de un protocolo de infusión continua de insulina para el control de la glucemia entre 100-140 mg/dl, evaluando los resultados mediante un método que considera todas las horas de tratamiento. Diseño. Estudio prospectivo observacional durante un período de dos meses y seguimiento hasta finalizar el tratamiento con insulina en perfusión. Ámbito. Unidad de Cuidados Intensivos polivalente de 23 camas. Pacientes. Cincuenta pacientes consecutivos mayores de 18 años con dos glucemias > 140 mg/dl distanciadas 4-6 horas. Se excluyeron los pacientes con dieta oral. Intervención. La velocidad de perfusión y la frecuencia de monitorización de la glucemia se realizaron de acuerdo con las normas del protocolo por parte del personal de enfermería. Principales variables de interés. Días de perfusión de insulina y número y valor de las glucemias realizadas. Se estudiaron los episodios de hipoglucemia, la glucemia media, el porcentaje de glucemias y de horas que el paciente estaba en cada tramo de glucemia. Resultados. La duración media del tratamiento fue 15,6 días (DE 12). Se recogieron un total de 17.768 horas y 8.111 glucemias. El 55,5% de las glucemias estuvieron entre 100-140 mg/dl, lo que representa el 63,9% de las horas. La glucemia media fue 133 mg/dl. Sólo se produjeron dos episodios de hipoglucemia severa (< 45 mg/dl). Conclusión. El protocolo fue seguro y permitió mantener un control glucémico adecuado. El análisis de todas las horas de tratamiento podría aportar más datos que el simple estudio del porcentaje de glucemias en el rango de la normalidad y la glucemia media

Objective. To analyze the efficacy and safety of a protocol for the continuous infusion of insulin to maintain blood glucose levels between 100 and 140 mg/dl, evaluating the results by a method that takes all of the hours of treatment into consideration. Design. Prospective observational study over a two-month period and follow up until the end of insulin perfusion. Context. Twenty three-bed polyvalent ICU. Patients. Fifty consecutive patients > 18 years of age with 2 episodes of glycemia > 140 mg/dl separated by 4-6 hours. Patients on an oral diet were excluded. Intervention. The perfusion rate and the frequency of glycemia monitoring were set according to the nursing staff’s protocol. Main variables of interest. Days of insulin perfusion and number and value of the blood glucose measurements taken. Episodes of hypoglycemia, mean blood glucose level, the percentage of hyperglycemia episodes, and the number of hours that the patient’s blood glucose was in each range. Results. The mean duration of treatment was 15.6 days (SD 12). A total of 17,768 hours and 8,111 blood glucose measurements were collected. 55.5% of the blood glucose measurements were between 100-140 mg/dl, and this represents 63.9% of the hours. The mean blood glucose level was 133 mg/dl. Only 2 episodes of severe hypoglycemia (< 45 mg/dl) occurred. Conclusion. The protocol was safe and enabled adequate control of blood glucose levels. The analysis of all of the hours of treatment might provide more data than a simple study of the percentages of blood glucose measurements within the normal range and the mean blood glucose level

[Implementation and evaluation of a protocol for continuous insulin perfusion in critical patients]. / Evaluación de un protocolo de perfusión continua de insulina en enfermos críticos.

OBJECTIVE: To analyze the efficacy and safety of a protocol for the continuous infusion of insulin to maintain blood glucose levels between 100 and 140 mg/dl, evaluating the results by a method that takes all of the hours of treatment into consideration. DESIGN: Prospective observational study over a two-month period and follow up until the end of insulin perfusion. CONTEXT: Twenty three-bed polyvalent ICU. PATIENTS: Fifty consecutive patients >18 years of age with 2 episodes of glycemia >140 mg/dl separated by 4-6 hours. Patients on an oral diet were excluded. INTERVENTION: The perfusion rate and the frequency of glycemia monitoring were set according to the nursing staff's protocol. MAIN VARIABLES OF INTEREST: Days of insulin perfusion and number and value of the blood glucose measurements taken. Episodes of hypoglycemia, mean blood glucose level, the percentage of hyperglycemia episodes, and the number of hours that the patient's blood glucose was in each range. RESULTS: The mean duration of treatment was 15.6 days (SD 12). A total of 17,768 hours and 8,111 blood glucose measurements were collected. 55.5% of the blood glucose measurements were between 100-140 mg/dl, and this represents 63.9% of the hours. The mean blood glucose level was 133 mg/dl. Only 2 episodes of severe hypoglycemia (<45 mg/dl) occurred. CONCLUSION: The protocol was safe and enabled adequate control of blood glucose levels. The analysis of all of the hours of treatment might provide more data than a simple study of the percentages of blood glucose measurements within the normal range and the mean blood glucose level.

[The coronary sulcus and ischemic cardiopathy: an independent association of risk factors]. / Surco coronario y cardiopatía isquémica: una asociación independiente de los factores de riesgo.

BACKGROUND: Coronary sulcus of the auricular lobe has been related to the presence of ischemic cardiopathy although the nature of this relation has not been well defined. The aim of the present study was to determine whether there is a relation between the sulcus and the classical coronary risk factors, or whether the association between coronariopathy and sulcus is independent of such factors. METHODS: Patients admitted into an intensive care unit (n = 222) were divided into two groups according to whether coronary sulcus was present and the following analysis were performed: 1) comparative study between the groups for the variables: age, sex, coronariopathy, hyperglycemia, hyperlipidemia, hypertension, index of body mass, and tobacco habit. 2) logistic regression analysis used as a variable to study the existence of coronary sulcus and as independent factors the different coronary risk factors. 3) calculation of sensitivity and specificity of the coronary sulcus as a marker of ischemic cardiopathy. RESULTS: In the comparison between groups the individuals with coronary sulcus had greater age, cholesterolemia, index of body mass, with greater frequency found in females with ischemic cardiopathy. In the logistic regression analysis the presence of coronary sulcus was only associated by order of statistical significance to the variables of age and the female sex. In this study, coronary sulcus was a sensitive (87.6%) although unspecific (41.2%) marker of coronariopathy. CONCLUSIONS: The prevalence of coronary sulcus increases with age, and is greater in patients with ischemic cardiopathy. This relation is independent of the classical coronary risk factors.