Senior Scholars Program

UMMS Affiliation

Department of Emergency Medicine; Senior Scholars Program

Faculty Advisor

Marie Mullen

Date

2-2010

Document Type

Article

Disciplines

Critical Care | Emergency Medicine | Endocrinology, Diabetes, and Metabolism

Abstract

OBJECTIVE: Glycemic control in the critically ill intensive care unit (ICU) patient has been shown to improve morbidity and mortality. We sought to investigate the effect of early glycemic control in critically ill emergency department (ED) patients in a small pilot trial.

METHODS: Adult non-trauma, non-pregnant ED patients presenting to a university tertiary referral center and identified as critically ill were eligible for enrollment on a convenience basis. Critical illness was determined upon assignment for ICU admission. Patients were randomized to either ED standard care or glycemic control. Glycemic control involved use of an insulin drip to maintain blood glucose levels between 80-140 mg/dL. Glycemic control continued until ED discharge. Standard patients were managed at ED attending physician discretion. We assessed severity of illness by calculation of APACHE II score. The primary endpoint was in-hospital mortality. Secondary endpoints included vasopressor requirement, hospital length of stay, and mechanical ventilation requirement.

RESULTS: Fifty patients were randomized, 24 to the glycemic group and 26 to the standard care cohort. Four of the 24 patients (17%) in the treatment arm did not receive insulin despite protocol requirements. While receiving insulin, three of 24 patients (13%) had an episode of hypoglycemia. By chance, the patients in the treatment group had a trend toward higher acuity by APACHE II scores. Patient mortality and morbidity were similar despite the acuity difference.

CONCLUSION: There was no difference in morbidity and mortality between the two groups. The benefit of glycemic control may be subject to source of illness and to degree of glycemic control, or have no effect. Such questions bear future investigation.

Rights and Permissions

Citation: Cohen J, Goedecke E, Cyrkler JE, Mangolds VB, Bateman J, Przyklenk K, Mullen MT. Early glycemic control in critically ill emergency department patients: pilot trial. West J Emerg Med. 2010 Feb;11(1):20-3. PubMed PMID: 20411069; PubMed Central PMCID: PMC2850847. Link to article on publisher's website

Related Resources

Link to article in PubMed

Comments

Jennifer Cyrkler participated in this study as a medical student as part of the Senior Scholars research program at the University of Massachusetts Medical School.

Copyright 2010 by the article author(s). This work is made available under the terms of the Creative Commons Attribution-NonCommercial4.0 license, http://creativecommons.org/licenses/by-nc/4.0/

PubMed ID

20411069

Creative Commons License

Creative Commons Attribution-Noncommercial 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License

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