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

Objective
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.
Design/Setting/Patients
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.
Intervention
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.
Outcomes
Mean daily BSV, mean daily insulin doses and number of nosocomial infections diagnosed during the patient’s SICU stay.
Results
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.
Conclusion
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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