Tag Archives: dexamethasone

Intravenous Insulin Protocol reduces time to Target Glucose in Critically ill Trauma and Burn patients

Oluwafolaranmi E. Sodade1*, Connor J. English2, Cindy L. Austin1, Charles A. Lunday3, Yang Wang4, Brian B. Draper5

1 Trauma and Burn Research, Mercy Hospital, Springfield, Missouri, USA
2 Kirksville College of Osteopathic Medicine, Kirksville, Missouri, USA
3 Clinical Pharmacy, Mercy Hospital, Springfield Missouri, USA
4 Enterprise Analytics, Mercy Health, East Chesterfield, Missouri, USA
5 General and Trauma Surgery, Mercy Clinic, Springfield, Missouri, USA

DOI: 10.2478/jccm-2026-0038

INTRODUCTION

Glycemic control is vital in the management of critically ill patients. Scientific evidence has proven that a drastic change in blood glucose levels can lead to adverse outcomes including increased hospital, ICU length of stay, morbidity, and mortality. Despite the challenges in developing standardized intravenous insulin protocols, institutions have successfully implemented protocols in various settings.

Our tertiary care hospital has an established intravenous insulin protocol for the cardiac ICU. Given the complexity of managing critically ill patients, an intravenous insulin protocol for such patients was implemented in February 2022.

AIM OF THE STUDY

The study aimed to evaluate the effectiveness of the newly implemented intravenous insulin protocol in glycemic control of critically ill trauma and burn patients.

MATERIAL AND METHODS

A single center retrospective chart review was conducted on 230 patients:119 patients were extracted from the pre-protocol implementation and 111 patients post-protocol implementation periods. Ninety-nine patients were excluded due to on-admission diagnosis of diabetic ketoacidosis, hyperosmolar hyperglycemic state, or incomplete data. Data collection included: type of injury; body mass index, pre-existing comorbidities; insulin administration times; target glucose actualization; glycemic events; hospital and ICU length of stay, mortality rates in the ICU, hospital, and 30 days post-hospitalization.

RESULTS

In the post-implementation group, the time to reach target glucose was significantly reduced when compared to the pre-implementation group. The rates of glycemic events after achieving target glucose were similar with a slightly lower rate post-implementation. There were no differences in the length of stay or mortality rates during hospitalization or 30-days post-hospitalization between the groups. However, when comparing routes of insulin administrations, the intravenous insulin significantly showed better glucose control and reduced the rates of glycemic events than the subcutaneous route.

CONCLUSION

Intravenous insulin protocol demonstrated a significant reduction in the time to target glucose levels for the critically ill patients.

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Association between steroid therapy and increased mortality in patients at risk for ARDS

Sultan Almuntashiri1, Andrew Bennett2,3, Duo Zhang3, Andrea Sikora4, Aaron Chase2,3

1 Department of Clinical Pharmacy, College of Pharmacy, University of Ha’il, Ha’il, Saudi Arabia
2 Department of Pharmacy, Augusta University Medical Center, Augusta, GA, USA
3 Department of Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, Augusta, GA, USA
4 Department of Biomedical Informatics, School of Medicine, University of Colorado, Aurora, CO, USA

DOI: 10.2478/jccm-2026-0037

Background: Corticosteroids are commonly used in critically ill patients with established risk factors for acute respiratory distress syndrome (ARDS), often for indications like sepsis or pneumonia, yet the choice of steroid and its impact on outcomes remain debated.
Methods: We conducted a retrospective analysis of 160 ICU patients with documented clinical risk factors for ARDS at the time of ICU admission to evaluate the effect of corticosteroid therapy on hospital mortality. Clinical characteristics, treatment variables, and outcomes were compared between patients who received corticosteroids and those who did not. A subgroup exploratory analysis further compared outcomes between dexamethasone and hydrocortisone users. Logistic regression models were used to identify mortality predictors.
Results: Of 160 patients, 91 (56.9%) received corticosteroids. Steroid-treated patients had higher Simplified Acute Physiology Score II (SAPS II) scores (54.4 vs. 48.0, p = 0.011), but no significant differences in age, partial pressure of arterial oxygen to fraction of inspired oxygen ratio (PaO₂/FiO₂), or mechanical ventilation use. Overall mortality was not significantly different between steroid and non-steroid users (42.9% vs. 33.3%, p = 0.221). Among steroid-treated patients, dexamethasone (n = 26) and hydrocortisone (n = 50) were the most frequently used agents. Mortality was significantly higher with hydrocortisone (58%) compared to dexamethasone (26.9%) (p = 0.010). In multivariate analysis, hydrocortisone use was associated with higher hospital mortality (adjusted OR = 4.41; 95% CI: 1.11–17.48; p = 0.035).
Conclusion: Overall corticosteroid use was not associated with improved survival in patients with documented clinical risk factors for ARDS; however, in an exploratory analysis, hydrocortisone use was associated with higher hospital mortality than dexamethasone. Given the retrospective observational design and real-world factors influencing corticosteroid selection, including illness severity, these findings should be interpreted with caution and support the need for prospective studies to clarify these associations.

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