The Impact of a Normoglycemic Management Protocol on Clinical Outcomes in the Trauma Intensive Care Unit

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Abstract
Background: The purpose of this study was to determine if protocol‐driven normoglycemic management in trauma patients affected glucose control, ventilator‐associated pneumonia, surgical‐site infection, and inpatient mortality. Methods: A prospective, consecutive‐series, historically controlled study design evaluated protocol‐driven normoglycemic management among trauma patients at Vanderbilt University Medical Center. Those mechanically ventilated ≥24 hours and ≥15 years of age were included. A glycemic‐control protocol required insulin infusion therapy for glucose >110 mg/dL. Control patients included those who met criteria, were admitted the year preceding protocol implementation, and had hyperglycemia treated at the physician's discretion. Results: Eight hundred eighteen patients met study criteria; 383 were managed without protocol; 435 underwent protocol. The protocol group had lower glucose levels 7 of 14 days measured. After admission, both groups had mean daily glucose levels vs 34.5%; p = .413), surgical infection (5.0% vs 5.7%; p = .645) or mortality (12.3% vs 13.1%; p = .722) occurred between groups. If one episode of blood glucose level was ≥150 mg/dL (n = 638; 78.0%), outcomes were worse: higher daily glucose levels for 14 days after admission (p < .001), pneumonia rates (35.9% vs 23.3%; p = .002), and mortality (14.6% vs 6.1%; p = .002). One or more days of glucose ≥150 mg/dL had a 2‐ to 3‐fold increase in the odds of death. Protocol use in these patients was not associated with outcome improvement. Conclusions: Protocol‐driven management decreased glucose levels 7 of 14 days after admission without outcome change. One or more glucose levels ≥150 mg/dL were associated with worse outcome.