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Reduction of Hyperglycemia and Nosocomial Infections in a General-Surgical Intensive-Care Unit

George A Perdrizet, Steven H. Fox, Kelly Swan, Suresh K Agarwal, Jr., Vincente Cortes, Neil J. Grey
Hartford Hospital-UCHC, Hartford, CT

To compare the incidence of nosocomial infections between two randomly matched cohorts of patients administered regular insulin by continuous infusion to achieve strict glycemic control or standard glycemic control.
A prospective, randomized, controlled blinded trial in a 12-bed general surgical intensive care unit at a 600-bed teaching hospital. Hyperglycemic (BSV≥140mg/dL) adult patients (> 18 yrs age) admitted to SICU. All patients were admitted to a general, trauma, or vascular surgical service. Approved obtained by the Institutional Review Board in compliance with the Helsinki Declaration of 1975 & 1983.
Patients were assigned to Strict (target BSV of 80-120mg/dL) or Standard (target BSV of 180-220mg/dL) Groups. Target BSV’s were achieved by a continuous infusion of regular insulin (0.5-1.0 IU/ml in 0.9% NaCl) for both groups.
Mean daily BSV, mean daily insulin doses and number of nosocomial infections diagnosed during the patient’s SICU stay.
Sixty-five patients (29 Standard, 36 Strict) completed the study. A significant reduction in mean daily BSV (Strict 125 ± 36 mg/dL vs Standard 179 ± 61 mg/dL, p<0.001) and in nosocomial infections (Strict 53 vs Standard 169 per thousand SICU days, p=0.002) was observed, including reductions in intravascular device, blood stream, and surgical-site infections. Hypoglycemia, (BSV <60mg/dL), occurred in 0.8% of Strict and 0.1% of Standard BSV, p= 0.027.
Strict glycemic control is a safe and effective method for reducing the incidence of nosocomial infections in a general-SICU patient population.

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