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Management of blood glucose in the critically ill in Australia and New Zealand: a practice survey and inception cohort study

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Abstract

Objective

To document current management of blood glucose in Australian and New Zealand intensive care units (ICUs) and to investigate the association between insulin administration, blood glucose concentration and hospital outcome.

Design and setting

Practice survey and inception cohort study in closed multi-disciplinary ICUs in Australia and New Zealand.

Patients

Twenty-nine ICU directors and 939 consecutive admissions to 29 ICUs during a 2-week period.

Measurement and results

Data collected included unit approaches to blood glucose management, patient characteristics, blood glucose concentrations, insulin administration and patient outcomes. Ten percent of the ICU directors reported using an intensive insulin regimen in all their patients. In 861 patients (91.7%) blood glucose concentration was greater than 6.1 mmol/l, 287 (31.1%) received insulin, and the median blood glucose concentration triggering insulin administration was 11.5 (IQR 9.4–14) mmol/l. Univariate analysis demonstrated that non-survivors had a higher maximum daily blood glucose concentration (12 mmol/l, 9.4–14.8, vs. 9.5, 7.6–12.2) and were more likely to receive insulin (47% vs. 28%). Multiple logistic regression analysis showed age (OR per 5-year decrease 0.93, 95% CI 0.87–1.00) and APACHE II (OR per point decrease 0.87, 95% CI 0.84–0.90) to be independently associated with hospital mortality. After controlling for age and APACHE II both daily highest blood glucose (OR 0.95, 95% CI 0.90–1.00) and administration of insulin (OR 0.62, 95% CI 0.39–1.00) were independently associated when added to the model alone; neither was independently associated when they were simultaneously included in the model.

Conclusion

Few Australian and New Zealand ICUs have adopted intensive insulin therapy. In this study, insulin administration and highest daily blood glucose concentration could not be separated in their association with hospital mortality.

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Acknowledgements

Site investigators (all in Australia unless otherwise specified) were: Auckland Hospital, New Zealand: C. McArthur, and L. Newby. Austin Hospital, R. Bellomo, D. Goldsmith, and S. Bates. Ballarat Base Hospital, T. Sutherland. Blacktown Hospital, G. Reece and M. Gopalakrisanan. The Canberra Hospital, I. Mitchell and R. Tamhane. Concord Hospital, D. Milliss. Flinders Medical Centre, T. Hunt. Green Lane Hospital, New Zealand: J. Beca and T. Ginger. Gold Coast Hospital, B. Richards and M. Tallot. Hornsby Hospital, J. Fratzia. John Hunter Hospital, B. McFadyen. Mater Misercordiae Hospital, P. Cook and L. Rudder. Monash Medical Centre, l. Lister. Nepean Hospital, I. Cole and L. Weisbrodt. North Shore Hospital, New Zealand: J. Liang. Port Macquarie Hospital, C. Hore. Prince Charles Hospital, D. Mullany. Prince of Wales Hospital, Y. Shehabi and H. Adamson. Royal Darwin Hospital, D. Stephens and J. Thomas. Royal Hobart Hospital, T. Bell and K. Marsden. Royal North Shore Hospital, S. Finfer and S. Dale. Royal Prince Alfred Hospital, R. Totaro and D. Rajbhandari. St George Hospital, J. Myburgh and M. Hodgetts. St Vincents Hospital, Melbourne: J. Santamaria. Tauranga Hospital, New Zealand: T. Browne. The Queen Elizabeth Hospital, S. Peake. The Royal Melbourne Hospital, J. Cade and C. Boyce. Wellington Hospital, New Zealand: P. Hicks and D. Durham. Western Hospital, C. French and L. Little. Dr Jeff Wood, Statistical Consulting Unit, The Graduate School, The Australian National University, Canberra, ACT 0200, Australia

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Mitchell, I., Finfer, S., Bellomo, R. et al. Management of blood glucose in the critically ill in Australia and New Zealand: a practice survey and inception cohort study. Intensive Care Med 32, 867–874 (2006). https://doi.org/10.1007/s00134-006-0135-4

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  • DOI: https://doi.org/10.1007/s00134-006-0135-4

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