Clinical Rounds

May 2011 
Volume 41  Number 5
Pages 27 - 29
  PDF Version Available!

New guidelines from the American College of Physicians (ACP) recommend not using intensive insulin therapy (IIT) to strictly control blood glucose or to achieve normoglycemia in patients in medical or nonsurgical ICUs. These guidelines apply both to patients with diabetes and those without diabetes.The ACP recommends a target glucose level of 140 to 200 mg/dL for patients who need insulin therapy. This range is associated with similar mortality outcomes as IIT targeted at blood glucose levels of 80 to 110 mg, but with a lower risk of hypoglycemia. In addition, some studies suggest that more aggressive glucose control is associated with higher mortality.The recommendations are based on an extensive systematic review of English-language studies published between 1950 and 2009.Source: Qaseem A, Humphrey LL, Chou R, Snow V, Shekelle P, et al. Use of intensive insulin therapy for the management of glycemic control in hospitalized patients: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2011; 154(4):260-267.Substantial reductions in central line-associated blood stream infections (CLABSIs) have occurred since 2001, according to a new report from the CDC. Between 2001 and 2009, CDC researchers found a 58% reduction in CLABSIs occurred in ICUs-a reduction that translates into 6,000 lives saved and significant savings in healthcare costs. Researchers credit effective state and federal initiatives and the efforts of healthcare professionals working to prevent healthcare-associated infections.While lauding this downward trend in ICUs, the CDC notes that CLABSI rates remain high in outpatient settings, especially hemodialysis facilities. To improve performance in these areas, the CDC recommends reducing central line use for hemodialysis and improving central line maintenance.Source: Vital Signs: Central line-associated blood stream infections-United States, 2001, 2008, and 2009. MMWR. 2011; March 1.Increased BP, common in acute stroke, is

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