AVALIAÇÃO DE UM PROTOCOLO DE INSULINOTERAPIA VENOSA EM UNIDADE DE TERAPIA INTENSIVA / EVALUATION OF A PROTOCOL OF INTRAVENOUS INSULIN THERAPY IN INTENSIVE CARE UNIT

Introducao : A hiperglicemia e considerada um agravante do estado clinico do paciente grave, sendo ele diabetico ou nao. Objetivo : Avaliar o protocolo de insulinoterapia venosa (ITV) realizado na UTI Geral do Hospital Universitario em Sao Luis-MA. Metodos : Pesquisa de carater prospectivo, descritivo com observacao sistematica. Foram incluidos pacientes admitidos na UTI geral que apresentaram mais de duas glicemias consecutivas acima de 150mg/dl, excluindo aqueles com menos de 24 horas de permanencia, gestantes e diabeticos com cetoacidose ou coma hiperosmolar. Resultados : A amostra foi constituida por 27 pacientes. A prevalencia de diabetes mellitus foi de 25,92%. Seis pacientes foram submetidos ao ITV e os demais foram acompanhados convencionalmente, com insulina regular subcutânea. Foi utilizado um total de 1336 unidades de insulina subcutânea nos 27 pacientes. Realizaram-se 700 glicemias capilares no grupo do protocolo e 949 no grupo convencional, o que comprova o controle mais frequente da glicemia na terapia de insulina venosa. O tempo medio de permanencia no protocolo foi de 63,25 horas, a infusao horaria media de insulina venosa foi 9,44 ml/h. A incidencia de mortalidade foi 66,6% dentre os pacientes submetidos ao protocolo de insulinoterapia venosa no grupo protocolo e 33,3% naqueles em terapia convencional. A incidencia de hipoglicemia moderada foi de 4,42% no grupo protocolo versus 2,63% no grupo convencional. As hipoglicemias severas nos pacientes do grupo protocolo representaram 7,14% do total e do grupo convencional 8,92%. Conclusao : O protocolo de insulinoterapia e importante para padronizar o atendimento ao paciente hiperglicemico na UTI. Palavras-chave : Hiperglicemia. Insulinoterapia. Unidade de Terapia. Abstract Introduction : Hyperglycemia is considered to be an aggravation of the clinical status of the critically ill patient, being a diabetic or not. Objective : To evaluate the intravenous insulin therapy protocol (ITV) performed in the General ICU of a university hospital in Sao Luis, MA. Methods : A prospective, descriptive research with systematic observation. Patients admitted to the general ICU were included if they had more than two consecutive blood glucose levels above 150 mg/dl, excluding those with less than 24 hours of stay, pregnant women and diabetics with ketoacidosis or hyperosmolar coma. Results : The sample consisted of 27 patients. The prevalence of diabetes mellitus was 25.92%. Six patients underwent ITV and the others were monitored conventionally, with subcutaneous regular insulin. A total of 1336 units of subcutaneous insulin were used in 27 patients. There were 700 capillary glucose in the protocol group and 949 in the conventional group, which proves more frequent blood glucose control in intravenous insulin therapy. The average length of stay in the protocol was approximately 63.25 hours; the average hourly infusion of intravenous insulin was 9.44 ml/h. The mortality rate was 66.6% among patients undergoing intravenous insulin therapy protocol in the protocol group and 33.3% in those on conventional therapy. The incidence of moderate hypoglycemia was 4.42% in the protocol group versus 2.63% in the conventional group. Severe hypoglycemia in the protocol group patients accounted for 7.14% of the total and 8.92% in the conventional group. Conclusion : The insulin therapy protocol is important to standardize the care to hyperglycemic patient in the ICU. Keywords : Hyperglycemia. Insulin therapy. Care Unit.