Early Glycemic Control in Critically Ill Emergency Department Patients: Pilot Trial
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,...
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| Format: | Article |
| Language: | English |
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eScholarship Publishing, University of California
2010-02-01
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| Series: | Western Journal of Emergency Medicine |
| Subjects: | |
| Online Access: | http://escholarship.org/uc/item/9q58571w |
| _version_ | 1818561153406599168 |
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| author | Cohen, Jason Goedecke, Eric Cyrkler, Jennifer E Mangolds, Virginia B Bateman, Jane Przyklenk, Karin |
| author_facet | Cohen, Jason Goedecke, Eric Cyrkler, Jennifer E Mangolds, Virginia B Bateman, Jane Przyklenk, Karin |
| author_sort | Cohen, Jason |
| collection | DOAJ |
| description | 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. [West J Emerg Med. 2010; 11(1):20-23]. |
| first_indexed | 2024-12-14T00:47:16Z |
| format | Article |
| id | doaj.art-ca99a88b34124166b9b705ccbea2d637 |
| institution | Directory Open Access Journal |
| issn | 1936-900X 1936-9018 |
| language | English |
| last_indexed | 2024-12-14T00:47:16Z |
| publishDate | 2010-02-01 |
| publisher | eScholarship Publishing, University of California |
| record_format | Article |
| series | Western Journal of Emergency Medicine |
| spelling | doaj.art-ca99a88b34124166b9b705ccbea2d6372022-12-21T23:24:03ZengeScholarship Publishing, University of CaliforniaWestern Journal of Emergency Medicine1936-900X1936-90182010-02-011112023Early Glycemic Control in Critically Ill Emergency Department Patients: Pilot TrialCohen, JasonGoedecke, EricCyrkler, Jennifer EMangolds, Virginia BBateman, JanePrzyklenk, KarinObjective: 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. [West J Emerg Med. 2010; 11(1):20-23].http://escholarship.org/uc/item/9q58571wglycemiccriticalemergency |
| spellingShingle | Cohen, Jason Goedecke, Eric Cyrkler, Jennifer E Mangolds, Virginia B Bateman, Jane Przyklenk, Karin Early Glycemic Control in Critically Ill Emergency Department Patients: Pilot Trial Western Journal of Emergency Medicine glycemic critical emergency |
| title | Early Glycemic Control in Critically Ill Emergency Department Patients: Pilot Trial |
| title_full | Early Glycemic Control in Critically Ill Emergency Department Patients: Pilot Trial |
| title_fullStr | Early Glycemic Control in Critically Ill Emergency Department Patients: Pilot Trial |
| title_full_unstemmed | Early Glycemic Control in Critically Ill Emergency Department Patients: Pilot Trial |
| title_short | Early Glycemic Control in Critically Ill Emergency Department Patients: Pilot Trial |
| title_sort | early glycemic control in critically ill emergency department patients pilot trial |
| topic | glycemic critical emergency |
| url | http://escholarship.org/uc/item/9q58571w |
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