%0 Journal Article
%T Which variables are associated with blood glucose levels outside the target range in surgical critically ill patients? A retrospective observational study
%A Manfred Weiss
%A Martina Kron
%A Birgit Hay
%A Michael Taenzer
%A Peter Radermacher
%A Michael Georgieff
%J Patient Safety in Surgery
%D 2011
%I BioMed Central
%R 10.1186/1754-9493-5-5
%X All critically ill surgical patients admitted to a university ICU, from 01/2007 to 12/2008, were surveyed daily using computer assistance with respect to minimal and maximal daily blood glucose concentrations, application of insulin and demographic/clinical variables. Multiple logistic regression for clustered data with backward elimination was performed to identify variables strongly associated with blood glucose concentrations < 80 mg/dl or ¡Ý 150 mg/dl in 804 patients with an ICU stay > 72 hours.Application of insulin (odds ratio (OR) 2.1, with corresponding 95% confidence interval (CI) 1.7; 2.6), noradrenaline (OR 1.4, 95% CI 1.2 - 1.8) or steroids (1.3, 1.003 - 1.7), and age (per year) (1.02, 1.01 - 1.03) were associated with an increased risk of blood glucose concentrations < 80 mg/dl. In analogy, application of insulin (OR 2.4, 95% CI 2.0 - 2.7), noradrenaline (1.4, 1.2 - 1.6) or steroids (1.4, 1.2 - 1.7), severe sepsis (1.2, 1.1 - 1.4), neurosurgery (OR 1.0) compared to abdominal, vascular and trauma surgery, and age (per year) (1.01, 1.01 - 1.02), were associated with an increased risk of blood glucose concentrations ¡Ý 150 mg/dl.Critically ill surgical patients are at an increased risk for fluctuating blood glucose concentrations ranging < 80 mg/dl or ¡Ý 150 mg/dl in particular if they are of advanced age and require administration of insulin, noradrenaline, and/or steroids. Patients who underwent neurosurgery and/or presented with severe sepsis/shock are those in particular at risk for blood glucose concentrations ¡Ý 150 mg/dl.In 2004 and 2008, the "Surviving Sepsis Campaign" (SSC) guidelines for the management of severe sepsis and septic shock were published to improve outcome of critically ill patients [1,2]. These guidelines recommend that patients with severe sepsis/septic shock and blood glucose concentrations ¡Ý 150 mg/dl receive IV insulin therapy to keep blood glucose levels in the range of 80 - 150 mg/dl [1,2]. A validated protocol for insulin dose ad
%U http://www.pssjournal.com/content/5/1/5