Validation of a glucose control protocol in septic patients with continuous venous glucose measurement

Introduction: Blood glucose control in critically-ill patients is still on debate. A protocolized approach and a tight control limiting wasting of patient's blood are useful to correctly manage glycaemia (1). Objective: Validation of glucose protocol (2) with a continuous blood glucose measurement (OptiScanner™ 5000). Materials/Methods: OptiScanner™ was used in 6 patients providing glucose measurement every 15 minutes from a CVC dedicated line, net drawing 9.6 ml blood/24h. 330 ml of saline/24h were reinfused. Target level was 80-160 mg/dL. Insulin infusion and kcal with nutritional support (NS) were recorded. Data are presented as median [interquartile range] (Sigmaplot11). Results: 6 septic patients, SAPSII 28 [26-34], were studied for 319 hours (1277 measurements); 58 [40-69] hours for each patient (measurements/patient: 231 [172-265]). Blood glucose was at target for 96.6% of study time (120 [113-131] mg/dL). Overall only 3 measurements showed hypoglycemic episodes (78, 78, 69 mg/dL). Blood glucose was >160 mg/dL in 44 measurements (3%:168 [163-173] mg/dL). Insulin infusion rate was 2.2 [1.2-2.9] UI/h; kcal/day uptake was 1436 [649-1761]. Conclusion: The local glucose control protocol mantained euglycaemia in septic patients with high safeness (blood glucose <80 mg/dL, 0.2%). Key points of the protocol are (2): 1. Lower blood glucose if >160 mg/dl before starting NS. 2. At the start of NS, provide insulin according to predicted stress status. 3. Targeting insulin need according to CHO/UI insulin observed. OptiScanner™ 5000 seemed useful to validate the protocol. References: 1) Dellinger RP Intensive Care Med. 2013;39(2):165-228. 2) Iapichino G Minerva Anestesiol. 2010;76(12):982-5.