Variation in stable carbon (δ13C) and nitrogen (δ15N) isotope compositions along antlers of Qamanirjuaq caribou (Rangifer tarandus groenlandicus).

Annual antler growth begins in the spring and is completed by late summer for male caribou (Rangifer tarandus groenlandicus) from the Qamanirjuaq herd (Nunavut, Canada), aligned with both the spring migration and a seasonal dietary shift. Antlers may provide a non-lethal means of studying short- and long-term changes in caribou ecology through incorporated isotopes of carbon (δ13C) and nitrogen (δ15N). We sampled the antlers of 12 male caribou from the Qamanirjuaq herd culled in September 1967. We predicted that serial sampling of antlers would reflect the known seasonal dietary change from lichen to grass-like and shrub diet based on rumen contents from individuals culled during the same period. The δ13C and δ15N were analyzed in food sources and every 3 cm along each antler's length. The carbon isotope compositions of collagen (δ13Ccol) varied by ~0.5‰ among individuals and within antlers, while the carbon isotope compositions of antler bioapatite (δ13CCO3) increased by 1-1.5‰ from pedicle to tip. Values of δ15Ncol increased within antlers by 1-3‰ from pedicle to tip and varied by 3‰ among the individuals sampled. Antler collagen was lower in δ15Ncol by ~1‰ relative to bone collagen. Bayesian mixing models were conducted to test for changes in dietary proportions from antler isotope compositions. Mixing models did not indicate significant dietary shifts for any individual during antler formation, showing consistently mixed diets of fungi, horsetail, lichen, and woody plants. Increases in δ15Ncol in antler tissue could, therefore, correspond to subtle seasonal dietary changes and/or the physiological stress of antler tissue development.

Investigating the reliability of metapodials as taxonomic Indicators for Beringian horses.

The metapodials of extinct horses have long been regarded as one of the most useful skeletal elements to determine taxonomic identity. However, recent research on both extant and extinct horses has revealed the possibility for plasticity in metapodial morphology, leading to notable variability within taxa. This calls into question the reliability of metapodials in species identification, particularly for species identified from fragmentary remains. Here, we use ten measurements of metapodials from 203 specimens of four Pleistocene horse species from eastern Beringia to test whether there are significant differences in metapodial morphology that support the presence of multiple species. We then reconstruct the body masses for every specimen to assess the range in body size within each species and determine whether species differ significantly from one another in mean body mass. We find that that taxonomic groups are based largely on the overall size of the metapodial, and that all metapodial measurements are highly autocorrelated. We also find that mean body mass differs significantly among most, but not all, species. We suggest that metapodial measurements are unreliable taxonomic indicators for Beringian horses given evidence for plasticity in metapodial morphology and their clear reflection of differences in body mass. We recommend future studies use more reliable indicators of taxonomy to identify Beringian horse species, particularly from localities from which fossils of several species have been recovered. Supplementary Information: The online version contains supplementary material available at 10.1007/s10914-022-09626-4.

Late quaternary biotic homogenization of North American mammalian faunas.

Biotic homogenization-increasing similarity of species composition among ecological communities-has been linked to anthropogenic processes operating over the last century. Fossil evidence, however, suggests that humans have had impacts on ecosystems for millennia. We quantify biotic homogenization of North American mammalian assemblages during the late Pleistocene through Holocene (~30,000 ybp to recent), a timespan encompassing increased evidence of humans on the landscape (~20,000-14,000 ybp). From ~10,000 ybp to recent, assemblages became significantly more homogenous (>100% increase in Jaccard similarity), a pattern that cannot be explained by changes in fossil record sampling. Homogenization was most pronounced among mammals larger than 1 kg and occurred in two phases. The first followed the megafaunal extinction at ~10,000 ybp. The second, more rapid phase began during human population growth and early agricultural intensification (~2,000-1,000 ybp). We show that North American ecosystems were homogenizing for millennia, extending human impacts back ~10,000 years.

Dietary niches of creodonts and carnivorans of the late Eocene Cypress Hills Formation.

Modern North American carnivorous mammal assemblages consist of species from a single clade: the Carnivora. Carnivorans once coexisted with members of other meat-eating clades, including the creodonts (Hyaenodontida and Oxyaenida). Creodonts, however, went extinct in North America during the late Eocene and early Oligocene, potentially due to niche overlap and resource competition with contemporary carnivorans. In this study, we employ a community ecology approach to understand whether the dietary niches of coexisting creodonts and carnivorans overlapped during the late Eocene (Chadronian North American Land Mammal Age), a time when creodonts were dwindling and carnivorans were diversifying. We quantify niche overlap based on inferences of diet from carnassial tooth shape estimated using Orientation Patch Count, Dirichlet's Normal Surface Energy, and linear dental measurements as well as from body mass for all species in the Calf Creek Local Fauna of Cypress Hills, Saskatchewan (Treaty 4 land). Although creodonts and carnivorans shared characteristics of their carnassial tooth shape, suggesting similar chewing mechanics and feeding habits, we find that marked differences in body size likely facilitated niche partitioning, at least between the largest creodonts and carnivorans. Calculations of prey focus masses and prey mass spectra indicate that only the smallest creodont may have experienced significant competition for prey with the coeval carnivorans. We suggest that the ultimate extinction of creodonts from North America during the late Eocene and Oligocene was unlikely to have been driven by factors related to niche overlap with carnivorans.

Pronghorn (Antilocapra americana) enamel phosphate δ18O values reflect climate seasonality: Implications for paleoclimate reconstruction.

Stable oxygen isotope (δ18O) compositions from vertebrate tooth enamel are widely used as biogeochemical proxies for paleoclimate. However, the utility of enamel oxygen isotope values for environmental reconstruction varies among species. Herein, we evaluate the use of stable oxygen isotope compositions from pronghorn (Antilocapra americana Gray, 1866) enamel for reconstructing paleoclimate seasonality, an elusive but important parameter for understanding past ecosystems. We serially sampled the lower third molars of recent adult pronghorn from Wyoming for δ18O in phosphate (δ18OPO4) and compared patterns to interpolated and measured yearly variation in environmental waters as well as from sagebrush leaves, lakes, and rivers (δ18Ow). As expected, the oxygen isotope compositions of phosphate from pronghorn enamel are enriched in 18O relative to environmental waters. For a more direct comparison, we converted δ18Ow values into expected δ18OPO4* values (δ18OW-PO4*). Pronghorn δ18OPO4 values from tooth enamel record nearly the full amplitude of seasonal variation from Wyoming δ18OW-PO4* values. Furthermore, pronghorn enamel δ18OPO4 values are more similar to modeled δ18OW-PO4* values from plant leaf waters than meteoric waters, suggesting that they obtain much of their water from evaporated plant waters. Collectively, our findings establish that seasonality in source water is reliably reflected in pronghorn enamel, providing the basis for exploring changes in the amplitude of seasonality of ancient climates. As a preliminary test, we sampled historical pronghorn specimens (1720 ± 100 AD), which show a mean decrease (a shift to lower values) of 1-2‰ in δ18OPO4 compared to the modern specimens. They also exhibit an increase in the δ18O amplitude, representing an increase in seasonality. We suggest that the cooler mean annual and summer temperatures typical of the 18th century, as well as enhanced periods of drought, drove differences among the modern and historical pronghorn, further establishing pronghorn enamel as excellent sources of paleoclimate proxy data.

Contamination Resulting From a Broken 125I Seed During a Brachytherapy Procedure.

ABSTRACT: Brachytherapy programs within radiation therapy departments are subject to stringent radiation safety requirements in order to ensure the safety of the staff and patients. Training programs often include brachytherapy-specific radiation safety training modules that address the specific risks associated with radioactive sources, emergency procedures, and regulatory requirements specific to the use of radioisotopes. Unlike other uses of radioactive materials, brachytherapy uses sealed sources and therefore under routine operations does not encounter radioactive contaminants. This article presents an unusual clinical situation in which an 125I brachytherapy seed was damaged during routine clinical workflow, resulting in radioactive contamination within the clinical environment. Decisions made at the time of the incident resulted in contamination that spread beyond the initial location. The incident highlighted a shortcoming of the radiation safety program in preparing staff for the possibility of having to deal with unsealed radioactivity. Brachytherapy programs would be strengthened by including training specific to radioactive contamination in their emergency training to equip staff to respond to unexpected damage to the sealed sources.

The preservation potential of terrestrial biogeographic patterns.

Extinction events in the geological past are similar to the present-day biodiversity crisis in that they have a pronounced biogeography, producing dramatic changes in the spatial distributions of species. Reconstructing palaeobiogeographic patterns from fossils therefore allows us to examine the long-term processes governing the formation of regional biotas, and potentially helps build spatially explicit models for future biodiversity loss. However, the extent to which biogeographic patterns can be preserved in the fossil record is not well understood. Here, we perform a suite of simulations based on the present-day distribution of North American mammals, aimed at quantifying the preservation potential of beta diversity and spatial richness patterns over extinction events of varying intensities, and after applying a stepped series of taphonomic filters. We show that taphonomic biases related to body size are the biggest barrier to reconstructing biogeographic patterns over extinction events, but that these may be compensated for by both the small mammal record preserved in bird castings, as well as range expansion in surviving species. Overall, our results suggest that the preservation potential of biogeographic patterns is surprisingly high, and thus that the fossil record represents an invaluable dataset recording the changing spatial distribution of biota over key intervals in Earth History.

Investigating Biotic Interactions in Deep Time.

Recent renewed interest in using fossil data to understand how biotic interactions have shaped the evolution of life is challenging the widely held assumption that long-term climate changes are the primary drivers of biodiversity change. New approaches go beyond traditional richness and co-occurrence studies to explicitly model biotic interactions using data on fossil and modern biodiversity. Important developments in three primary areas of research include analysis of (i) macroevolutionary rates, (ii) the impacts of and recovery from extinction events, and (iii) how humans (Homo sapiens) affected interactions among non-human species. We present multiple lines of evidence for an important and measurable role of biotic interactions in shaping the evolution of communities and lineages on long timescales.

Mammal Community Structure through the Paleocene-Eocene Thermal Maximum.

AbstractHuman-mediated species invasion and climate change are leading to global extinctions and are predicted to result in the loss of important axes of phylogenetic and functional diversity. However, the long-term robustness of modern communities to invasion is unknown, given the limited timescales over which they can be studied. Using the fossil record of the Paleocene-Eocene thermal maximum (PETM; ∼56 Ma) in North America, we evaluate mammalian community-level response to a rapid global warming event (5°-8°C) and invasion by three Eurasian mammalian orders and by species undergoing northward range shifts. We assembled a database of 144 species body sizes and created a time-scaled composite phylogeny. We calculated the phylogenetic and functional diversity of all communities before, during, and after the PETM. Despite increases in the phylogenetic diversity of the regional species pool, phylogenetic diversity of mammalian communities remained relatively unchanged, a pattern that is invariant to the tree dating method, uncertainty in tree topology, and resolution. Similarly, body size dispersion and the degree of spatial taxonomic turnover of communities remained similar across the PETM. We suggest that invasion by new taxa had little impact on Paleocene-Eocene mammal communities because niches were not saturated. Our findings are consistent with the numerous studies of modern communities that record little change in community-scale richness despite turnover in taxonomic composition during invasion. What remains unknown is whether long-term robustness to biotic and abiotic perturbation are retained by modern communities given global anthropogenic landscape modification.

Reorganization of surviving mammal communities after the end-Pleistocene megafaunal extinction.

Large mammals are at high risk of extinction globally. To understand the consequences of their demise for community assembly, we tracked community structure through the end-Pleistocene megafaunal extinction in North America. We decomposed the effects of biotic and abiotic factors by analyzing co-occurrence within the mutual ranges of species pairs. Although shifting climate drove an increase in niche overlap, co-occurrence decreased, signaling shifts in biotic interactions. Furthermore, the effect of abiotic factors on co-occurrence remained constant over time while the effect of biotic factors decreased. Biotic factors apparently played a key role in continental-scale community assembly before the extinctions. Specifically, large mammals likely promoted co-occurrence in the Pleistocene, and their loss contributed to the modern assembly pattern in which co-occurrence frequently falls below random expectations.

Phylogenetic signal in tooth wear dietary niche proxies: What it means for those in the field.

In response to DeSantis et al., we describe that the presence of phylogenetic signal in tooth wear dietary niche proxies is likely a result of the evolutionary process. We also address their concerns regarding enforcement of the use of phylogenetic comparative methods by editors of ecology and evolution journals.

Phylogenetic signal in tooth wear dietary niche proxies.

In the absence of independent observational data, ecologists and paleoecologists use proxies for the Eltonian niches of species (i.e., the resource or dietary axes of the niche). Some dietary proxies exploit the fact that mammalian teeth experience wear during mastication, due to both tooth-on-tooth and food-on-tooth interactions. The distribution and types of wear detectible at micro- and macroscales are highly correlated with the resource preferences of individuals and, in turn, species. Because methods that quantify the distribution of tooth wear (i.e., analytical tooth wear methods) do so by direct observation of facets and marks on the teeth of individual animals, dietary inferences derived from them are thought to be independent of the clade to which individuals belong. However, an assumption of clade or phylogenetic independence when making species-level dietary inferences may be misleading if phylogenetic niche conservatism is widespread among mammals. Herein, we test for phylogenetic signal in data from numerous analytical tooth wear studies, incorporating macrowear (i.e., mesowear) and microwear (i.e., low-magnification microwear and dental microwear texture analysis). Using two measures of phylogenetic signal, heritability (H2) and Pagel's λ, we find that analytical tooth wear data are not independent of phylogeny and failing to account for such nonindependence leads to overestimation of discriminability among species with different dietary preferences. We suggest that morphological traits inherited from ancestral clades (e.g., tooth shape) influence the ways in which the teeth wear during mastication and constrain the foods individuals of a species can effectively exploit. We do not suggest that tooth wear is simply phylogeny in disguise; the tooth wear of individuals and species likely varies within some range that is set by morphological constraints. We therefore recommend the use of phylogenetic comparative methods in studies of mammalian tooth wear, whenever possible.

A toothless dwarf dolphin (Odontoceti: Xenorophidae) points to explosive feeding diversification of modern whales (Neoceti).

Toothed whales (Odontoceti) are adapted for catching prey underwater and possess some of the most derived feeding specializations of all mammals, including the loss of milk teeth (monophyodonty), high tooth count (polydonty), and the loss of discrete tooth classes (homodonty). Many extant odontocetes possess some combination of short, broad rostra, reduced tooth counts, fleshy lips, and enlarged hyoid bones-all adaptations for suction feeding upon fishes and squid. We report a new fossil odontocete from the Oligocene (approx. 30 Ma) of South Carolina (Inermorostrum xenops, gen. et sp. nov.) that possesses adaptations for suction feeding: toothlessness and a shortened rostrum (brevirostry). Enlarged foramina on the rostrum suggest the presence of enlarged lips or perhaps vibrissae. Phylogenetic analysis firmly places Inermorostrum within the Xenorophidae, an early diverging odontocete clade typified by long-snouted, heterodont dolphins. Inermorostrum is the earliest obligate suction feeder within the Odontoceti, a feeding mode that independently evolved several times within the clade. Analysis of macroevolutionary trends in rostral shape indicate stabilizing selection around an optimum rostral shape over the course of odontocete evolution, and a post-Eocene explosion in feeding morphology, heralding the diversity of feeding behaviour among modern Odontoceti.

The changing role of mammal life histories in Late Quaternary extinction vulnerability on continents and islands.

Understanding extinction drivers in a human-dominated world is necessary to preserve biodiversity. We provide an overview of Quaternary extinctions and compare mammalian extinction events on continents and islands after human arrival in system-specific prehistoric and historic contexts. We highlight the role of body size and life-history traits in these extinctions. We find a significant size-bias except for extinctions on small islands in historic times. Using phylogenetic regression and classification trees, we find that while life-history traits are poor predictors of historic extinctions, those associated with difficulty in responding quickly to perturbations, such as small litter size, are good predictors of prehistoric extinctions. Our results are consistent with the idea that prehistoric and historic extinctions form a single continuing event with the same likely primary driver, humans, but the diversity of impacts and affected faunas is much greater in historic extinctions.

Original Research: Implementation of an Early Mobility Program in an ICU.

OBJECTIVE: Research is needed to determine the feasibility of implementing a dedicated ICU mobility team in community hospital settings. The purpose of this study was to assess, in one such hospital, four nurse-sensitive quality-of-care outcomes (falls, ventilator-associated events, pressure ulcers, and catheter-associated urinary tract infections [CAUTIs]), as well as hospital costs, sedation and delirium measures, and functional outcomes by comparing ICU patients who received physical therapy from a dedicated mobility team with ICU patients who received routine care. METHODS: We conducted a retrospective longitudinal study at a community acute care hospital; patients were randomly assigned to intervention or routine care groups. The mobility team screened patients Monday through Friday using a mobility algorithm to determine eligibility for participation in each early mobility session. Based on their strength, balance, hemodynamic stability, and ability to participate in early mobility activities, patients advanced through four progressively difficult phases of mobility. Data were collected and analyzed after patients were discharged from the hospital. RESULTS: The 66 patients who received the mobility intervention had significantly fewer falls, ventilator-associated events, pressure ulcers, and CAUTIs than the 66 patients in the routine care group. The mobility group also had lower hospital costs, fewer delirium days, lower sedation levels, and improved functional independence compared with the routine care group. Patients in the mobility group got out of bed on 2.5 more days than patients in the routine care group. There were also no adverse events in the mobility group. CONCLUSIONS: It is feasible for a community hospital to create and implement a dedicated ICU mobility team. Early mobilization of ICU patients contributed to fewer delirium days and improved patient outcomes, sedation levels, and functional status.

Controlled feeding trials with ungulates: a new application of in vivo dental molding to assess the abrasive factors of microwear.

Microwear, the quantification of microscopic scratches and pits on the occlusal surfaces of tooth enamel, is commonly used as a paleodietary proxy. For ungulates (hoofed mammals), scratch-dominant microwear distinguishes modern grazers from browsers, presumably as a result of abrasion from grass phytoliths (biogenic silica). However, it is also likely that exogenous grit (i.e. soil, dust) is a contributing factor to these scratch-dominant patterns, which may reflect soil ingestion that varies with feeding height and/or environmental conditions (e.g. dust production in open and/or arid habitats). This study assessed the contribution of exogenous grit to tooth wear by measuring the effects of fine- and medium-grained silica sand on tooth enamel using a novel live-animal tooth-molding technique. It therefore constitutes the first controlled feeding experiment using ungulates and the first in vivo experiment using abrasives of different sizes. Four sheep were fed three diet treatments: (1) a mixture of Garrison and Brome hay (control), (2) hay treated with fine-grained silica sand (180-250 µm) and (3) hay treated with medium-grained silica sand (250-425 µm). We found a significant increase in pit features that was correlated with an increase in grain size of grit, corroborating earlier chewing simulation experiments that produced pits through grit-induced abrasion (i.e. the 'grit effect'). Our results support an interpretation of large silica grains fracturing to create smaller, more abundant angular particles capable of abrasion, with jaw movement defining feature shape (i.e. scratch or pit).

Mean annual precipitation explains spatiotemporal patterns of Cenozoic mammal beta diversity and latitudinal diversity gradients in North America.

Spatial diversity patterns are thought to be driven by climate-mediated processes. However, temporal patterns of community composition remain poorly studied. We provide two complementary analyses of North American mammal diversity, using (i) a paleontological dataset (2077 localities with 2493 taxon occurrences) spanning 21 discrete subdivisions of the Cenozoic based on North American Land Mammal Ages (36 Ma--present), and (ii) climate space model predictions for 744 extant mammals under eight scenarios of future climate change. Spatial variation in fossil mammal community structure (ß diversity) is highest at intermediate values of continental mean annual precipitation (MAP) estimated from paleosols (∼ 450 mm/year) and declines under both wetter and drier conditions, reflecting diversity patterns of modern mammals. Latitudinal gradients in community change (latitudinal turnover gradients, aka LTGs) increase in strength through the Cenozoic, but also show a cyclical pattern that is significantly explained by MAP. In general, LTGs are weakest when continental MAP is highest, similar to modern tropical ecosystems in which latitudinal diversity gradients are weak or undetectable. Projections under modeled climate change show no substantial change in ß diversity or LTG strength for North American mammals. Our results suggest that similar climate-mediated mechanisms might drive spatial and temporal patterns of community composition in both fossil and extant mammals. We also provide empirical evidence that the ecological processes on which climate space models are based are insufficient for accurately forecasting long-term mammalian response to anthropogenic climate change and inclusion of historical parameters may be essential.

Complexity of ruminant masticatory evolution.

The evolution of robust jaws, hypsodont teeth, and large chewing muscles among grazing ruminants is a quintessential example of putative morphological adaptation. However, the degree of correlated evolution (i.e., to what extent the grazer feeding apparatus represents an evolutionary module), especially of soft and hard tissues, remains poorly understood. Recent generation of large datasets and phylogenetic information has made testing hypotheses of correlated evolution possible. We, therefore, test for correlated evolution among various traits of the ruminant masticatory apparatus including tooth crown height, jaw robustness, chewing muscle size, and characters of the molar occlusal surfaces, using phylogenetic and nonphylogenetic comparative methods as well as phylogenetic evolutionary model selection. We find that the large masseter muscles of grazing ruminants evolved with the inclusion of grass in the diet, an increase in the proportion of occlusal enamel bands oriented parallel to the chewing stroke, and possibly hypsodonty. We suggest that the masseter evolved under two evolutionary regimes: i) selection for higher masticatory forces during chewing and ii) flattening of the tooth profile, which resulted in reduced tooth guidance and, thus, a requirement for more chewing muscle activity during each chewing stroke, in agreement with previous research. The linear jaw metrics (depth of the mandibular angle, mandibular angle width, and length of the superficial masseteric scar) all show correlated evolution with hypsodonty and the proportion of enamel bands oriented parallel to the chewing stroke. We suggest that changes in the shape of the mandible represent the combined effects of selection for a reorientation of the chewing stroke, so as to emphasize horizontal translation of the teeth, and accommodation of high-crowned teeth. Our analyses show that the ruminant feeding apparatus is an evolutionary mosaic with its various components showing both correlated and independent evolution.

Early evolution of sexual dimorphism and polygyny in Pinnipedia.

Sexual selection is one of the earliest areas of interest in evolutionary biology. And yet, the evolutionary history of sexually dimorphic traits remains poorly characterized for most vertebrate lineages. Here, we report on evidence for the early evolution of dimorphism within a model mammal group, the pinnipeds. Pinnipeds show a range of sexual dimorphism and mating systems that span the extremes of modern mammals, from monomorphic taxa with isolated and dispersed mating to extreme size dimorphism with highly ordered polygynous harem systems. In addition, the degree of dimorphism in pinnipeds is closely tied to mating system, with strongly dimorphic taxa always exhibiting a polygynous system, and more monomorphic taxa possessing weakly polygynous systems. We perform a comparative morphological description, and provide evidence of extreme sexual dimorphism (similar to sea lions), in the Miocene-aged basal pinniped taxon Enaliarctos emlongi. Using a geometric morphometric approach and combining both modern and fossil taxa we show a close correlation between mating system and sex-related cranial dimorphism, and also reconstruct the ancestral mating system of extant pinnipeds as highly polygynous. The results suggest that sexual dimorphism and extreme polygyny in pinnipeds arose by 27 Ma, in association with changing climatic conditions.

Evaluation of an intensive insulin transition protocol in the intensive care unit setting: a before and after study / Evaluación de un protocolo de transición de insulina intensiva en una unidad de cuidados intensivos: estudio antes-después

The benefits of controlling blood glucose levels in intensive care units (ICUs) are well documented. Objective: This study determined the effectiveness and safety of a standardized transition order set for converting a continuous insulin infusion to a subcutaneous insulin regimen in non-cardiovascular surgery ICUs patient population. Methods: A retrospective study was conducted. Patients presenting with diabetic ketoacidosis or hyperosmolar hyperglycemic syndrome were excluded. One hundred patients were included prior to and 100 patients were included after initiating the transition order set. Blood glucose control was reviewed for up to 72 hours following the transition. Results: A total of 115 patients were included in data analysis: 85 prior to and 30 after transition protocol. All patients transitioned using the protocol were transitioned to basal insulin, compared to only 40% of the prior to protocol group. Patients transitioned correctly per the transition order set, «per protocol», had 54% of blood sugars within the desired range, no increase in hypoglycemic events, and on average 5.56 hyperglycemic events (blood glucose >180 mg/dL) per person during the 72 hours compared to 6.68 and 9.00 for the prior to protocol group and the «off protocol» group (transitioned different than the protocol recommended), respectively (p= 0.05). There were significant differences in blood sugar control at 48 and 72 hours between the «per protocol» and «off protocol» groups (p= 0.01) and a 40% reduction in sliding scale or correctional insulin coverage. Conclusion: The addition of basal insulin to transition regimens resulted in fewer hyperglycemic events with no increase in hypoglycemic events. Patients transitioned «per protocol» had better glucose control demonstrated by: less hyperglycemic events, lower mean blood glucose levels at 48 and 72 hours, and lower need for correctional insulin. These findings showed benefits of glycemic control in the ICU by following a standardized transition protocol (AU)

Los beneficios de controlar la glucemia en las unidades de cuidados intensivos (UCI) están ben documentados. Objetivo: Este estudio determinó la efectividad y seguridad de un orden de transición estandarizado para convertir un régimen de insulina de infusión continua a un régimen de insulina subcutánea en una población de pacientes de UCI de cirugía no vascular. Métodos: Se realizó un estudio retrospectivo. Se excluyó a los pacientes que presentaban cetoacidosis diabética o síndrome hiperglucémico hiperosmolar. Se incluyo a 100 pacientes antes y después de iniciar el sistema de transición. Se revisó la glucemia hasta 72 horas después de la transición. Resultados: Un total de 115 pacientes fueron incluidos para el análisis de datos: 85 antes y 35 después del protocolo de transición. Todos los pacientes que transitaron usando el protocolo pasaron a insulina basal, comparados con sólo el 40% del grupo de antes del protocolo. El 54% de los pacientes que transitaron correctamente con el protocolol, «por protocolo» tuvieron la glucemia en el rango deseado, sin aumento de eventos hipoglucémicos, y con un 5,56% de eventos hiperglucémicos (glucemia>180 mg/dL) durante las 72 horas de vigilancia, comparados con el 6,68% y 9,00% respectivamente para el grupo anterior al protocolo y el grupo «fuera de protocolo» (que transitó diferente a lo recomendado por el protocolo) (p=0,05). Hubo diferencia significativas en el control glucémico a las 48 y 72 horas entre los grupos «por protocolo» y «fuera de protocolo» (p=0,01) y un 40% de reducción en la escala descendente o cobertura de insulina de corrección. Conclusión: La adición de insulina basal a los regímenes de transición provocó menores eventos hiperglicémicos sin aumento de eventos hipoglicémicos. Los pacientes que transitaron «por protocolo» tuvieron mejor control glucémico, demostrado por: menores eventos hiperglucémicos, menores niveles medios de glucemia a las 48 y 72 horas, y menor necesidad de corrección de insulina. Estos hallazgos demostraron los beneficios de un control glucémico en la UCI siguiendo un protocolo estandarizado de transición (AU)