Nurse led protocols for control of glycaemia in critically ill patients: A systematic review |
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| Institution: | 1. Department of Emergency Medicine, Royal London Hospital, Barts Health NHS Trust, London, UK;2. Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy;3. Department of Health Sciences, Magna Graecia University, Catanzaro, Italy;4. School of Nursing, Department of Translational Medicine, Eastern Piedmont University, Novara, Italy;1. Centre for Care Excellence, University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, United Kingdom;2. Therapies, University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, United Kingdom;1. Intensive Care Unit, Consorci Hospitalari de Vic (CHV), Vic, Spain;2. University of Vic - Central University of Catalonia (UVic-UCC), Vic, Spain;1. Dept. of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium;2. Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium;3. Infectious Disease and Infection Control Service, ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy;4. School of Healthcare, Nurse education programme, HOGENT University of Applied Sciences and Arts, Ghent, Belgium |
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| Abstract: | BackgroundBlood glucose control in critically ill patients is challenging and can affect clinical outcomes. Several manual as well as automated approaches have been proposed over the time, however nursing staff still covers the key-role for optimization of glycemia throughout adjustment of insulin infusion and administration.AimSystematic review to compare the efficacy/the effects of nurse led insulin infusion protocols versus standard approaches in patients admitted in the intensive care unit.MethodsAll relevant studies evaluating nurse directed protocols for insulin administration in critically ill adults. Data was independently extracted and collected through a dedicated electronic form. The following outcomes have been recorded: the number (or percentage) of glycaemia measurements within the target range; the number of hypo- and hyper-glycaemic events, separately; the mean glycaemia; the lowest and highest glycemia values recorded; the time to reach the glycaemia target; the ICU length of stay and the ICU and the long-term (>30 days) mortality. Statistical analysis was conducted on the summary statistics of the selected articles (eg, means, medians, proportions). Unpaired nonparametric continuous data were compared through the Mann-Whitney U-test.ResultsGlycaemic control as well as ICU length of stay and mortality are similar in both patients' groups. Specifically, the group of patients treated with standard modalities include those treated with doctors led protocols, paper charts or software-based approaches.ConclusionOverall, nurse led insulin protocols can effectively control blood glucose level among critically ill patients. |
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| Keywords: | Glycaemic control Nurse led protocol Insulin Glycaemia Intensive Care Unit |
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