The Impact of Intensive Insulin Protocols and Restrictive Blood Transfusion Strategies on Glucose Measurement in American Burn Association (ABA) Verified Burn Centers

Abstract

The prevalence of intensive insulin and restrictive blood use protocols in burn centers is unknown, which may be problematic as the combined impact of these therapies is to concomitantly increase the prevalence of anemia and hypoglycemia in intensive care unit patients. Such a development is important because point-of-care (POC) glucometers report erroneously high values in the presence of low hematocrit (HCT), potentially masking the presence of hypoglycemia. We hypothesized that most American Burn Association (ABA) verified burn centers have adopted intensive insulin therapy while simultaneously restricting blood transfusions potentially increasing risk of hypoglycemia. All ABA verified burn centers (N = 44) were contacted. Clinical practices regarding intensive insulin therapy, restrictive transfusion practices, and the use of POC glucometers were evaluated. Intensive insulin protocols were implemented at 73% of ABA centers (defined as upper glucose target of less than or equal to 120 mg/dl) and POC glucometers measurement was nearly universal; 95% of ABA centers use them routinely. Anemia is prevalent in intensive care units and may be increasing because of recent changes in practice. Defined hemoglobin and HCT levels trigger blood transfusion at 84% of centers, and of these, 51% restrict transfusion to hemoglobin less than 7 g/dl or HCT less than 22%. Most ABA centers now use intensive insulin protocols, many in combination with restrictive transfusion strategies. The combination of a higher prevalence of hypoglycemia in the presence of near universal anemia is concerning, particularly given the pervasiveness of glucometer use among burn centers.

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Document Details

Document Type
Technical Report
Publication Date
Oct 01, 2008
Accession Number
ADA627734

Entities

People

  • Charles E Wade
  • Elizabeth A. Mann
  • Heather Pidcoke
  • John B Holcomb
  • Josè Salinas
  • Steven Wolf

Organizations

  • United States Army Institute of Surgical Research

Tags

Communities of Interest

  • Biomedical

DTIC Thesaurus Topics

  • Analyzers
  • Blood
  • Blood Transfusions
  • Burns
  • Chemistry
  • Combat Casualty Care
  • Glucose Metabolism Disorders
  • Health Services
  • Infection
  • Intensive Care Units
  • Measurement
  • Medical Personnel
  • Patient Care
  • Point-Of-Care Diagnostic Testing
  • Therapy
  • United States

Fields of Study

  • Medicine

Readers

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  • Trauma Surgery or Emergency Medicine.