Escalas pronósticas en la disfunción multiorgánica: estudio de cohortes / Predictive scoring systems in multiorgan failure: A cohort study

OBJETIVO: Valorar el grado en que las escalas pronósticas son capaces de predecir la mortalidad hospitalaria. DISEÑO: Estudio de cohortes retrospectivo de 2 años. ÁMBITO: UCI médico-quirúrgica de un hospital de tercer nivel. PACIENTES: Todos los pacientes con síndrome de disfunción multiorgánica en el primer día de ingreso. Variables de interés: APACHE II y IV, SAPS II y III, MPM II y muerte hospitalaria. RESULTADOS: Se incluyeron 568 pacientes. Mortalidad hospitalaria: 39,8% (226 pacientes). Discriminación (área bajo la curva; IC 95%): APACHE IV (0,805; 0,751-0,858), SAPS II (0,755; 0,697-0,814), MPM II (0,748; 0,688-0,809), SAPS III (0,737; 0,675-0,799) y APACHE II (0,699; 0,633-0,765). El MPM II es el que mejor calibra, seguido por el SAPS III. APACHE II, SAPS II y APACHE IV presentan una muy mala calibración. Razón estandarizada de mortalidad (IC 95%): APACHE IV 1,9 (1,78-2,02); APACHE II 1,1 (1,07-1,13); SAPS III 1,1 (1,06-1,14); SAPS II 1,03 (1,01-1,05); MPM 0,9 (0,86-0,94). CONCLUSIONES: APACHE IV tiene la mejor capacidad discriminativa y mala calibración. MPM II tiene una buena discriminación y la mejor calibración. En cuanto al SAPS II, mantiene la segunda mejor discriminación y una mala calibración. El APACHE II muestra unos valores de calibración y discriminación que desaconsejarían su utilización en la actualidad, y el SAPS III mantiene una adecuada calibración y una discriminación moderada. La valoración de estos resultados podría marcar el inicio de nuevos estudios a nivel regional/nacional en determinadas poblaciones de pacientes críticos

OBJECTIVE: An evaluation is made of the hospital mortality predicting capacity of the main predictive scoring systems. DESIGN: A 2-year retrospective cohort study was carried out. SETTING: A third level ICU with surgical and medical patients. PATIENTS: All patients with multiorgan failure during the first day in the ICU. Main variables: APACHE II and IV, SAPS II and III, MPM II and hospital mortality. RESULTS: A total of 568 patients were included. Mortality rate: 39.8% (226 patients). Discrimination (area under the ROC curve; 95% CI): APACHE IV (0.805; 0.751-0.858), SAPS II (0.755; 0.697-0.814), MPM II (0.748; 0.688-0.809), SAPS III (0.737; 0.675-0.799) and APACHE II (0.699; 0.633-0.765). MPM II showed the best calibration, followed by SAPS III. APACHE II, SAPS II and APACHE IV showed very poor calibration. Standard mortality ratio (95% CI): APACHE IV 1.9 (1.78-2.02); APACHE II 1.1 (1.07-1.13); SAPS III 1.1 (1.06-1.14); SAPS II 1.03 (1.01-1.05); MPM 0.9 (0.86-0.94). CONCLUSIONS: APACHE IV showed the best discrimination, with poor calibration. MPM II showed good discrimination and the best calibration. SAPS II, in turn, showed the second best discrimination, with poor calibration. The APACHE II calibration and discrimination values currently disadvise its use. SAPS III showed good calibration with modest discrimination. Future studies at regional or national level and in certain critically ill populations are needed

Predictive scoring systems in multiorgan failure: A cohort study.

OBJECTIVE: An evaluation is made of the hospital mortality predicting capacity of the main predictive scoring systems. DESIGN: A 2-year retrospective cohort study was carried out. SETTING: A third level ICU with surgical and medical patients. PATIENTS: All patients with multiorgan failure during the first day in the ICU. MAIN VARIABLES: APACHE II and IV, SAPS II and III, MPM II and hospital mortality. RESULTS: A total of 568 patients were included. Mortality rate: 39.8% (226 patients). Discrimination (area under the ROC curve; 95% CI): APACHE IV (0.805; 0.751-0.858), SAPS II (0.755; 0.697-0.814), MPM II (0.748; 0.688-0.809), SAPS III (0.737; 0.675-0.799) and APACHE II (0.699; 0.633-0.765). MPM II showed the best calibration, followed by SAPS III. APACHE II, SAPS II and APACHE IV showed very poor calibration. Standard mortality ratio (95% CI): APACHE IV 1.9 (1.78-2.02); APACHE II 1.1 (1.07-1.13); SAPS III 1.1 (1.06-1.14); SAPS II 1.03 (1.01-1.05); MPM 0.9 (0.86-0.94). CONCLUSIONS: APACHE IV showed the best discrimination, with poor calibration. MPM II showed good discrimination and the best calibration. SAPS II, in turn, showed the second best discrimination, with poor calibration. The APACHE II calibration and discrimination values currently disadvise its use. SAPS III showed good calibration with modest discrimination. Future studies at regional or national level and in certain critically ill populations are needed.

«RETRATO» (REgistro de TRAuma grave de la provincia de TOledo): visión general y mortalidad / «RETRATO» (REgistro de TRAuma grave de la provincia de TOledo): General view and mortality

Objetivo: Análisis del tratamiento y de la evolución del enfermo traumático crítico. Diseño: Estudio descriptivo y retrospectivo. Ámbito: Las UCI de la provincia de Toledo. Pacientes: Todos los pacientes con enfermedad traumática ingresados durante el período 2001-2007 (7 años). Variables de interés principales: Variables en el lugar del accidente, prehospitalarias, durante el transporte; variables de ingreso hospitalario y de evolución hasta el alta o el fallecimiento. Resultados: Se incluyó a 1.090 pacientes traumáticos ingresados. El 79,5% eran varones. La edad mediana fue de 36,5 años (>65 años [16%]). El descenso fue progresivo desde el año 2001 (142 pacientes) hasta el año 2007 (133 pacientes). El 46,9% ingresó entre mayo y septiembre. El 29,4% no pertenecía al área sanitaria. Las causas fueron accidente de coche (43,3%), precipitación/caída (20,8%), accidente de moto (13,8%) y atropello de peatón (6,6%). Hubo 2.172 lesiones. El 30,1% tenía 3 lesiones y el 8,4% tenía 4 o más lesiones. La lesión más frecuente fue el traumatismo craneoencefálico (33,7%), seguido por el trauma torácico (20,2%) y el trauma ortopédico (15,6%). El 36,4% necesitó cirugía en el primer día. La estancia media en la UCI fue de 10,4±13,2 días. El tiempo de ventilación mecánica fue de 7,3±12 días (mediana de 1 día). El 15% falleció en la UCI. Permanecieron en modelo multivarible de predicción de mortalidad en la UCI incluyendo las variables prehospitalarias: edad (OR: 1,05; IC95%: 1,03-1,06), midriasis (OR: 2,6; IC95%:1,3-5,3), componente motor del Glasgow Coma Score (OR: 0,7; IC95%: 0,6-0,8), shock prehospitalario (OR: 3,2; IC95%: 1,8-5,5) e Injury Severity Score (OR: 1,1; IC95%: 1,05-1,1). Conclusiones: La utilización de registros de trauma multicéntricos da una idea global del tratamiento y permite incidir en la mejora de los cuidados (AU)

Objective: To analyze the management and progression of the critical trauma patient. Design: A retrospective, descriptive analysis. Setting: The ICU in the province of Toledo. Patients: All patients with traumatic injury admitted during the 2001-2007 period (7 years). Main variables of interest: These include the variables at the scene of the accident, pre-hospitalization, during transportation, variables on admission and during development until discharge or death. Results: A total of 1090 trauma patients admitted were included. Of these, 79.5% were male, with an average age of 36.5 years (16% >65 years). There was a progressive decrease of patients from 2001 (142 patients) to 2007 (133 patients), with 46.9% admissions between May and September. A total of 29.4% did not belong to the health area. The causes were car accident (43.3%), fall from a height/fall (20.8%), motorcycle accident (13.8%), pedestrian being run over (6.6%). There were 2172 injuries; 30.1% had 3 injuries and 8.4% >4. The most frequently occurring injury was a head injury (33.7%), followed by thoracic trauma (20.2%) and orthopedic trauma (15.6%). 36.4% required surgery on the first day. Average length of stay in the ICU was 10.4±13.2 days. Time on mechanical ventilation was 7.3±12 days (median 1 day). Fifteen percent died in the ICU. This remains within the multivariable ICU mortality prediction model, including the pre-hospitalization variables: age (OR 1.05; 95% CI: 1.03-1.06), mydriasis (OR 2.6; 95% CI: 1.3-5.3), motor component of the Glascow Coma Score (GCS) (OR 0.7; 95% CI: 0.6-0.8), pre-hospitalization shock (OR 3.2; 95% CI: 1.8-5.5) and Injury Severity Score (ISS) (OR 1.1; 95% CI: 1.05-1.1). Conclusions: The use of multicenter trauma registers gives an overall view of trauma management and helps improve the care (AU)

Sincronía auriculo-ventricular en pacientes portadores de marcapasos con estimulación VDD. Estudio descriptivo de un periodo de 14 años / Atrioventricular synchrony in patients with pacemaker with VDD mode pacing. A 14-year descriptive study

Objetivo: Analizar el rendimiento de la estimulación con marcapasos de modalidad VDD en pacientes con bloqueo auriculo-ventricular (AV) completo con especial atención a la permanencia en sincronía AV. Diseño: Se trata de un estudio retrospectivo observacional, descriptivo sobre una serie de casos. Ámbito: Servicio de Medicina Intensiva de un centro hospitalario de tercer nivel. Pacientes: Totalidad de pacientes con marcapasos VDD implantado entre 1994-2008. Variables: Se analizó causa de trastorno del ritmo, tiempo de mantenimiento de la sincronía AV, motivo de la pérdida de la misma, número de recambios de generador y motivo, edad a la que se hizo el primoimplante, incidencia de fallo de sensado auricular y de fibrilación auricular. Se comparó la población que entro en Fibrilación auricular con el resto que mantenían actividad auricular. Resultados: Se analizaron 95 pacientes, 49 (51,6%) varones y 46 (48,4%) mujeres con edad media de Edad 77,08±8,37 años. El síntoma más frecuente fue el presíncope y mareo con 43 casos (45,3%), el trastorno del ritmo más frecuente fue el bloqueo AV de IIIo con QRS ancho con 68 casos (71,6%). El tiempo medio de Sincronía AV mantenida fue de 73,01±4,2 meses, sin diferencias significativas entre diferentes causas de pérdida de la misma. Al final del estudio permanecían en sincronía AV estudio 56 casos (73,3%). Conclusiones: El tiempo de sincronía AV es elevado, siendo las causas más importantes de su pérdida, la entrada en fibrilación auricular y el infrasensado auricular (AU)

Objective: To analyze the performance of VDD mode pacing in patients with complete AV block with special attention on maintaining AV synchrony. Design: This is a descriptive, retrospective and observational study of a case series. Setting: Intensive Medicine Department of a tertiary Hospital. Patients: All patients with VDD pacemakers implanted between 1994 and 2008. Main measurements: The cause of the rhythm disorder, time of atrioventricular synchrony, cause of its loss, number of pacemaker replacement and reason, age when the first implant was performed, incidence of failure of atrial sensing and atrial fibrillation. We compared patients with atrial fibrillation with the rest who maintained normal atrial activity. Results: A total of 95 patients, 49 (51.6%) males and 46 (48.4%) female with mean age of 77.08±8.37 years, were analyzed. The most common symptom was dizziness and presyncope in 43 cases (45.3%), the most common rhythm disorder was the III AV block with wide QRS with 68 cases (71.6%). Average time of AV synchrony was maintained 73.01±4.2 months with no significant differences between different causes of synchrony loss. At the end of the study, 56 cases remained in AV synchrony (73.3%). Conclusions: The preservation time of AV synchrony is high, the most important causes of loss being entry in atrial fibrillation and atrial infrasensing (AU)

Evaluación de la eosinopenia como marcador de infección en pacientes ingresados en una Unidad de Cuidados Intensivos / Evaluation of eosinopenia as an infection marker in critical care patients

Objetivo: Evaluar la eosinopenia como marcador precoz de infección. Diseño: Estudio de cohortes retrospectivo. Pacientes: Enfermos de una UCI medicoquirúrgica con altos índices de gravedad. Variables de interés: Datos demográficos, diagnóstico, repercusión clínica, necesidad de ventilación mecánica, evolución, estancia y Acute Physiology and Chronic Health Evaluation II (APACHE II) en primeras 24h. Días 1-5: leucocitos y fórmula, plaquetas, SOFA y lactato. Pacientes divididos en 2 grupos: con y sin infección. Mejor punto de discriminación según curvas ROC. Resultados: Doscientos cuarenta y cuatro pacientes; 55 (22,5%) infectados. El 52,9% eran enfermos médicos, el 22,5% eran enfermos posquirúrgicos y el 24,6% eran enfermos politraumatizados. El APACHE II fue de 14,9±8,9. En regresión logística (variable dependiente de infección) las variables independientes son APACHE II, SOFA, monocitos y eosinófilos. La curva ROC para eosinófilos el primer día muestra área de 0,72; mejor punto de corte: 10 eosinófilos/ml, sensibilidad (S): el 64,8% y especifidad (E): el 70,9%. En pacientes médicos, el área bajo la curva ROC es de 0,80, con punto de corte ideal de 9 eosinófilos/ml; en pacientes quirúrgicos el área bajo la curva es de 0,53, con punto de corte de 54 eosinófilos/ml. Si combinamos eosinófilos y monocitos, el corte de 9 eosinófilos/ml en pacientes médicos con >400 monocitos/ml, tiene una S del 86,7%, una E del 74,7%, un valor predictivo positivo del 40,6% y un valor predictivo negativo del 96,6%; en pacientes posquirúrgicos con <400 monocitos/ml y punto de corte de 54 eosinófilos, una S del 100%, una E del 20%, un valor predictivo positivo del 52,9% y un valor predictivo negativo del 100%. Conclusiones: En una UCI medicoquirúrgica la eosinopenia no muestra buena capacidad discriminativa de presencia de infección, aunque combinada con la cifra de monocitos podría ser útil para descartarla (AU)

Introduction: To evaluate eosinopenia as an early marker of infection. Design: Retrospective cohort study. Patients: Medical-surgical ICU patients with high severity scores. Main variables: Data on days 1-5: Demographic data, diagnosis, clinical repercussion, mechanical ventilation, clinical development, length of stay, APACHE II, leukocytes, SOFA and lactate. Patients divided into two groups: with and without infection. ROCs (receiver operator characteristic) curves were plotted and best point for discriminative values determined. Results: 244 patients were included: 22.5% with infection. 52.9% medical, 22.5% surgical and 24.6% polytrauma patients. APACHE II: 14.9±8.9. In a logistic regression model of infection (dependent variable infection), the independent variables were: APACHE II, SOFA, monocytes and eosinophils. The ROC curve for eosinophils on the first day: area of 0.72; the best cut off value is 10 eosinophils/ml, with sensitivity (S): 64.8% and specificity (Sp): 70.9%. In medical patients, the area under curve is 0.80, with ideal cut off value of 9 eosinophils/ml; in surgical patients is 0.53, with a cut off ideal value of 54. We combined eosinophils and monocytes: a cut-off value of 9 eosinophils/ml in medical patients with >400 monocytes/ml, has: S: 86.7%, Sp: 74.7%, a positive predictive value (PPV) of 40.6% and a negative predictive value (NPV) 96.6%; in postsurgical patients with <400 monocytes/ml and a cut-off value of 54 eosinophils: S: 100%, Sp: 20%, PPV: 52.9% and NPV: 100%. Conclusions: In a medical-surgical ICU, the capacity to discriminate infection through examining eosinopenia is not high. It could be useful to rule out infection if we combined eosinopenia with monocytes count (AU)

[<> (REgistro de TRAuma grave de la provincia de TOledo): general view and mortality]. / <> (REgistro de TRAuma grave de la provincia de TOledo): visión general y mortalidad.

OBJECTIVE: To analyze the management and progression of the critical trauma patient. DESIGN: A retrospective, descriptive analysis. SETTING: The ICU in the province of Toledo. PATIENTS: All patients with traumatic injury admitted during the 2001-2007 period (7 years). MAIN VARIABLES OF INTEREST: These include the variables at the scene of the accident, pre-hospitalization, during transportation, variables on admission and during development until discharge or death. RESULTS: A total of 1090 trauma patients admitted were included. Of these, 79.5% were male, with an average age of 36.5 years (16% ≥ 65 years). There was a progressive decrease of patients from 2001 (142 patients) to 2007 (133 patients), with 46.9% admissions between May and September. A total of 29.4% did not belong to the health area. The causes were car accident (43.3%), fall from a height/fall (20.8%), motorcycle accident (13.8%), pedestrian being run over (6.6%). There were 2172 injuries; 30.1% had 3 injuries and 8.4% ≥ 4. The most frequently occurring injury was a head injury (33.7%), followed by thoracic trauma (20.2%) and orthopedic trauma (15.6%). 36.4% required surgery on the first day. Average length of stay in the ICU was 10.4+/-13.2 days. Time on mechanical ventilation was 7.3+/-12 days (median 1 day). Fifteen percent died in the ICU. This remains within the multivariable ICU mortality prediction model, including the pre-hospitalization variables: age (OR 1.05; 95% CI: 1.03-1.06), mydriasis (OR 2.6; 95% CI: 1.3-5.3), motor component of the Glascow Coma Score (GCS) (OR 0.7; 95% CI: 0.6-0.8), pre-hospitalization shock (OR 3.2; 95% CI: 1.8-5.5) and Injury Severity Score (ISS) (OR 1.1; 95% CI: 1.05-1.1). CONCLUSIONS: The use of multicenter trauma registers gives an overall view of trauma management and helps improve the care.

[Atrioventricular synchrony in patients with pacemaker with VDD mode pacing. A 14-year descriptive study]. / Sincronía auriculo-ventricular en pacientes portadores de marcapasos con estimulación VDD. Estudio descriptivo de un periodo de 14 años.

OBJECTIVE: To analyze the performance of VDD mode pacing in patients with complete AV block with special attention on maintaining AV synchrony. DESIGN: This is a descriptive, retrospective and observational study of a case series. SETTING: Intensive Medicine Department of a tertiary hospital. PATIENTS: All patients with VDD pacemakers implanted between 1994 and 2008. MAIN MEASUREMENTS: The cause of the rhythm disorder, time of atrioventricular synchrony, cause of its loss, number of pacemaker replacement and reason, age when the first implant was performed, incidence of failure of atrial sensing and atrial fibrillation. We compared patients with atrial fibrillation with the rest who maintained normal atrial activity. RESULTS: A total of 95 patients, 49 (51.6%) males and 46 (48.4%) female with mean age of 77.08+/-8.37 years, were analyzed. The most common symptom was dizziness and presyncope in 43 cases (45.3%), the most common rhythm disorder was the III AV block with wide QRS with 68 cases (71.6%). Average time of AV synchrony was maintained 73.01+/-4.2 months with no significant differences between different causes of synchrony loss. At the end of the study, 56 cases remained in AV synchrony (73.3%). CONCLUSIONS: The preservation time of AV synchrony is high, the most important causes of loss being entry in atrial fibrillation and atrial infrasensing.

[Evaluation of eosinopenia as an infection marker in critical care patients]. / Evaluación de la eosinopenia como marcador de infección en pacientes ingresados en una Unidad de Cuidados Intensivos.

INTRODUCTION: To evaluate eosinopenia as an early marker of infection. DESIGN: Retrospective cohort study. PATIENTS: Medical-surgical ICU patients with high severity scores. MAIN VARIABLES: Data on days 1-5: Demographic data, diagnosis, clinical repercussion, mechanical ventilation, clinical development, length of stay, APACHE II, leukocytes, SOFA and lactate. Patients divided into two groups: with and without infection. ROCs (receiver operator characteristic) curves were plotted and best point for discriminative values determined. RESULTS: 244 patients were included: 22.5% with infection. 52.9% medical, 22.5% surgical and 24.6% polytrauma patients. APACHE II: 14.9+/-8.9. In a logistic regression model of infection (dependent variable infection), the independent variables were: APACHE II, SOFA, monocytes and eosinophils. The ROC curve for eosinophils on the first day: area of 0.72; the best cut off value is 10 eosinophils/microl, with sensitivity (S): 64.8% and specificity (Sp): 70.9%. In medical patients, the area under curve is 0.80, with ideal cut off value of 9 eosinophils/microl; in surgical patients is 0.53, with a cut off ideal value of 54. We combined eosinophils and monocytes: a cut-off value of 9 eosinophils/microl in medical patients with >400 monocytes/microl, has: S: 86.7%, Sp: 74.7%, a positive predictive value (PPV) of 40.6% and a negative predictive value (NPV) 96.6%; in postsurgical patients with <400 monocytes/microl and a cut-off value of 54 eosinophils: S: 100%, Sp: 20%, PPV: 52.9% and NPV: 100%. CONCLUSIONS: In a medical-surgical ICU, the capacity to discriminate infection through examining eosinopenia is not high. It could be useful to rule out infection if we combined eosinopenia with monocytes count.

[Ischemic optic neuropathy in the multiple trauma victim]. / Neuropatía óptica isquémica en el paciente politraumatizado.

Ischemic optic neuropathy is an uncommon of blindness in the critically ill patient that occurs especially in multiple trauma victims with no direct injury of the eyeball. We present the case of a young male patient with total bilateral blindness after profound hemorrhagic shock secondary to thoracoabdominal non-penetrating traumatism caused by crushing. A search of the literature was conducted, identifying prolonged arterial hypotension and sudden drop in hematocrit value as the most important risk factors.

Neuropatía óptica isquémica en el paciente politraumatizado / Ischemic optic neuropathy in the multiple trauma victim

neuropatía óptica isquémica es una causapoco conocida de ceguera en el paciente crítico yespecialmente en el politraumatizado sin daño directodel globo ocular. Presentamos el caso de unpaciente joven que desarrolla una ceguera bilateralcompleta tras sufrir un profundo shock hemorrágicosecundario a un traumatismo toracoabdominalcerrado por aplastamiento. Se ha realizado una revisión de la literatura relacionada y se han identificado como factores de riesgo más importantes la hipotensión arterial prolongada y el descenso brusco del hematocrito

Ischemic optic neuropathy is an uncommon ofblindness in the critically ill patient that occurs especially in multiple trauma victims with no directinjury of the eyeball. We present the case of ayoung male patient with total bilateral blindnessafter profound hemorrhagic shock secondary tothoracoabdominal non-penetrating traumatismcaused by crushing. A search of the literature wasconducted, identifying prolonged arterial hypotensionand sudden drop in hematocrit value as the most important risk factors (AU)

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.