Moderate glycemic control safe in critically ill adult burn XXXX : A 15 year cohort study.

@entity1 @entity1735 @entity4053 @entity4854 @entity413 @entity130
INTRODUCTION: @entity4854 is a metabolic alteration in major burn @entity1 associated with complications. The study aimed at evaluating the safety of general ICU @entity413 control protocols applied in major burns receiving prolonged ICU treatment. METHODS: 15year retrospective analysis of consecutive, adult burn @entity1 admitted to a single specialized centre. EXCLUSION CRITERIA: death or length of stay <10 days, age <16years. VARIABLES: demographic variables, burned surface (TBSA), severity scores, infections, ICU stay, outcome. Metabolic variables: total energy, @entity1735 and insulin delivery/24h, arterial blood @entity413 and CRP values. Analysis of 4 periods: 1, before protocol; 2, tight doctor driven; 3, tight nurse driven; 4, moderate nurse driven. RESULTS: 229 @entity1 , aged 45  20 years (mean  SD), burned 32  20% TBSA were analyzed. SAPSII was 35  13. TBSA, Ryan and ABSI remained stable. @entity130 increased. A total of 28,690 blood @entity413 samples were analyzed: the median value remained unchanged with a narrower distribution over time. After the protocol initiation, the normoglycemic values increased from 34.7% to 65.9%, with a reduction of hypoglycaemic events (no extreme @entity4053 in period 4). Severe @entity4854 persisted throughout with a decrease in period 4 (9.25% in period 4). Energy and @entity413 deliveries decreased in periods 3 and 4 (p<0.0001). Infectious complications increased during the last 2 periods (p=0.01). CONCLUSION: A standardized ICU @entity413 control protocol improved the glycemic control in adult burn @entity1 , reducing @entity413 variability. Moderate glycemic control in burns was safe specifically related to @entity4053 , reducing the incidence of hypoglycaemic events compared to the period before. @entity4854 persisted at a lower level.
