Biomedical subjects

James Krinsley

Publications and source records attributed to James Krinsley.

4 recordsLinked to original sources

PubMed2006

Implementing an intensive glucose management initiative: strategies for success.

Glycemic control has become a hallmark for this ICU. Collectively, staff and hospital leaders changed a culture of casual attitudes toward chaotic glycemic control to an evidence-based atmosphere of decreased mortality, which has received local and national recognition. Implementation of a protocol , which seemed radical at the time, showed significant patient outcomes. Characterized by teamwork and education, the process was developed, initiated and continually evaluated for improvement, with a cornerstone of patient safety. The rich database allows for continual analysis of outcomes.

Blood Glucose↗

PubMed2006

Perioperative glucose control.

PURPOSE OF REVIEW: Hyperglycemia occurs commonly among acutely ill patients owing to a combination of counterregulatory and stress responses, as well as insulin resistance and deficiency, and is associated with increased morbidity and mortality in a variety of different patient populations. This manuscript reviews the adverse consequences of hyperglycemia in these different settings and focuses on perioperative glycemic management. RECENT FINDINGS: Hyperglycemia has a number of effects on the native immune system that may explain its role in increasing the risk of infection. Insulin may exert its beneficial effects by altering lipid metabolism as well as by modulating endothelial function through several mechanisms. Hyperglycemia during cardiac surgery is associated with increased risk of postoperative complications, including death. Several interventional studies have concluded that intensive glycemic management is beneficial, but there are limited data available from general surgical populations. SUMMARY: Hyperglycemia is associated with adverse outcomes in acutely ill adult patients and its treatment has been shown to improve mortality and morbidity in a variety of different settings. Additional studies are needed in heterogeneous populations of critically ill patients as well as in other populations of acutely ill patients, especially general surgical patients, to confirm the early studies and define the correct glycemic target.

Blood Glucose↗

PubMed2005

Intensive glycemic management in critically ill patients.

BACKGROUND: The effect of an intensive glycemic management protocol was assessed in a heterogeneous population of critically ill adult patients. METHODS: Patients representing 800 consecutive admissions following the institution of the protocol were compared with the 800 admissions immediately preceding the institution of the protocol in a 14-bed mixed medical-surgical intensive care unit (ICU). The protocol used intensive monitoring and treatment to maintain blood glucose values >140 mg/dl. Continuous intravenous insulin was used if glucose values were >200 mg/dl on two successive occasions. RESULTS: Mean glucose decreased from 152.3 mg/dl to 130.7 mg/dl (p < .001), marked by a 56.3% reduction in the percentage of glucose values > or =200 mg/dl, without a significant change in hypoglycemia. There were decreases in the development of new renal insufficiency (p = .034) and in the number of patients receiving transfusion of packed red blood cells (p = .035) during the protocol period. Hospital mortality decreased 29.3% (p = .002), and ICU length of stay decreased 10.8% (p = .011) after institution of the protocol. DISCUSSION: The 29.3% relative reduction in hospital mortality seen among the treatment patients following institution of the protocol probably exceeded the expectations of the initiative's champions. The culture of the ICU regarding glycemic control changed definitively. The protocol was extended to an intermediate care unit, resulting in improvement in glycemic control without an increase in hypoglycemia.

Blood Component Transfusion↗

PubMed2005

Glucose control reduces ICU stay and mortality.

Intensive monitoring and control of blood glucose levels in intensive care unit patients has resulted in significant clinical improvements at The Stamford Hospital in Stamford, CT. Mortality for ICU patients is down 29%, while the length of stay in the ICU has decreased by nearly 11%.

Blood Glucose↗