Improving Stress-Induced Hyperglycemia Management in the Intensive Care Setting

Abstract

Background: Uncontrolled stress-induced hyperglycemia has been shown to increase mortality, prolong ICU length of stay, increase complications, and prolong ICU length of stay. The inadequate management of stress-induced hyperglycemia in the intensive care setting is a persistent gap in quality care. Objective: To implement an evidence-based Stress-induced hyperglycemia protocol in the ICU at NorthBay Medical Center. Design: Descriptive design with pre-and post-intervention measurement. Setting: The Intensive Care Unit at NorthBay Medical Center. Patients: 22 patients with stress-induced hyperglycemia. Eligible patients had a blood glucose level great than or equal to 150 mg/dL. Intervention: Patients with a blood glucose level greater than or equal to 150 mg/dL were started on sliding scale insulin therapy. Patients with a blood glucose level greater than 180 mg/dl the patient were started on an insulin infusion. If the blood glucose levels were <100 mg/dl, insulin therapy was discontinued to prevent hypoglycemia. Blood glucose levels were integrated into ICU multidisciplinary rounds to ensure all patients with stress-induced hyperglycemia were identified. Measurements: ICU length of stay, hospital length of stay, average high blood glucose levels, and number of patients who met criteria but were not started on insulin therapy were measured. Results: The average ICU length of stay pre-protocol implementation (M=4.18, SD=2.48) was greater than the average ICU length of stay post-protocol implementation (M=2.18, SD=1.83). This difference is statistically significant t (20) =2.15, p=0.044; d 0.95. There was no significant 8 difference between pre-protocol implementation hospital length of stay (M=9.27, SD=9.50) and post-protocol implementation hospital length of stay (M=6.27, SD=3.82); t (20) =0.97, p=0.343. There was no significant difference in average blood glucose levels pre-implementation (M=197, SD=69) and post-protocol implementation (M=189, SD=40); t (20) =0.31, p=0.76. Over half (55%) of the patients in the pre-implementation group met criteria for stress-induced hyperglycemia, however, insulin therapy was not initiated by the ICU healthcare provider. Postimplementation, there was 100% compliance with initiating therapy on those patients that met criteria.