Use of Computer-Based Insulin Delivery Method in Management of Pediatric Diabetic Ketoacidosis (DKA) in a Pediatric Intensive Care Unit (PICU)

Use of Computer-Based Insulin Delivery Method in Management Of Pediatric Diabetic Ketoacidosis (DKA) in a Pediatric Intensive Care Unit (PICU)

Presentation

World Congress on Pediatric Intensive and Critical Care

Date

May 2014

Authors

U Narsinghani,1 J Hutchins,1 B Smith2

Background

DKA can be prevented, but accounts for a large proportion of mortality, morbidity and hospitalizations in patients with dlabetes, and contributes to the high costs of diabetes care. Treatment of DKA requires hydration and frequent intravenous (IV) fluid modifications. No studies have shown clinical benefit of rate of glucose or bicarbonate correction.

Aims

We studied the use of Glucommander, a computer-based system to direct IV insulin infusion using blood glucose (BG) measurements. It utilizes a weight based algorithm to suggest a multiplier for pediatric patients. New recommendations are offered hourly based on glucose measurements; the multiplier is adjusted up or down depending on the patient’s proximity to the target BG.

Methods

After IRB approval a retrospective chart review was conducted on patients admitted to PICU from January 2009-December 2009. Inclusion criteria were defined as patient’s ages 1-18 years with diagnosis of DKA and/or type 1 diabetes. Patients were treated with the Glucommander. Key outcome measures were analyzed (Table 1). Adverse events were recorded.

Results

39/59 patients met inclusion criteria. Average age of patients was 11.82 + 4.36 years (2-17). 38.46% had new diagnosis of Type 1 diabetes. There were 69.23% females and 30.77% males. Results are stated in Table 1.


Table 1: Results
Outcomes Mean +SD Median Range
Admission BG (mg/dL) 447.26 + 273.50 408.00 64.00 - 1323.00
Admission CO2 (mmol/L) 11.14 + 4.67 11.00 5.00 - 22.00
Correction to Acidosis [CO2 >16mmol/L] Hrs 17.66 + 12.33 13.25 4.58 - 58.70
PICU LOS (Hrs) 33.16 + 20.77 24.78 10.03 - 96.27
Insulin Units/kg/Hour (IV) 0.10 + 0.15 0.05 0.01 - 0.89
Time on Glucommander (Hrs) 17.46 + 7.23 16.27 4.50 - 41.28

Conclusions

Use of Glucommander is safe and effective for management of pediatric patients with DKA. There was no hypoglycemia, neurologic complications or mortality/morbidity. Use of the Glucommander achieves portability, user friendliness, staff satisfaction, and was intuitively less error prone.

Affiliations

  1. Mercer University School of Medicine, Pediatrics, and The Children's Hospital at The Medical Center of Central Georgia, Macon, Georgia.
  2. Mercer University School of Medicine, Internal Medicine, and The Children's Hospital at The Medical Center of Central Georgia, Macon, Georgia.
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