Comparison of 2 intravenous insulin protocols: Glycemia variability in critically ill patients. / Comparación de 2 protocolos de insulina intravenosa: variabilidad de la glucemia en pacientes críticos.

OBJECTIVE: Glycemic variability is an independent predictor of mortality in critically ill patients. The objective of this study was to compare two intravenous insulin protocols in critically ill patients regarding the glycemic variability. MATERIAL AND METHODS: This was a retrospective observational study performed by reviewing clinical records of patients from a Critical Care Unit for 4 consecutive months. First, a simpler Scale-Based Intravenous Insulin Protocol (SBIIP) was reviewed and later it was compared for the same months of the following year with a Sliding Scale-Based Intravenous Insulin Protocol (SSBIIP). All adult patients admitted to the unit during the referred months were included. Patients in whom the protocol was not adequately followed were excluded. A total of 557 patients were reviewed, of whom they had needed intravenous insulin 73 in the first group and 52 in the second group. Four and two patients were excluded in each group respectively. RESULTS: Glycemic variability for both day 1 (DS1) and total stay (DST) was lower in SSBIIP patients compared to SBIIP patients: SD1 34.88 vs 18.16 and SDT 36.45 vs 23.65 (P<.001). CONCLUSION: A glycemic management protocol in critically ill patients based on sliding scales decreases glycemic variability.

Comparación de 2 protocolos de insulina intravenosa: variabilidad de la glucemia en pacientes críticos / Comparison of 2 intravenous insulin protocols: Glycemia variability in critically ill patients

Objetivo: La variabilidad glucémica es un predictor independiente de la mortalidad en pacientes críticos. El objetivo del presente estudio es comparar 2 protocolos de administración de insulina intravenosa en críticos en cuanto a la variabilidad glucémica se refiere. Material y métodos: Se trata de un estudio observacional retrospectivo realizado mediante revisión de historias clínicas de los pacientes de una unidad de críticos durante 4 meses consecutivos. Primero se revisó un protocolo de insulina más simple o protocolo de insulina intravenosa basado en una escala (PIVBE), que fue comparado con los mismos meses del siguiente año donde se utilizó protocolo insulina intravenosa basado en escalas dinámicas (PIVBED). Se incluyó a todos los pacientes, adultos, ingresados en la unidad durante los meses referidos. Se excluyó a los pacientes en los que el protocolo no se siguió correctamente. Se revisó a 557 pacientes, de los cuales habían necesitado insulina intravenosa 73 en el primer grupo y 52 en el segundo. Fueron excluidos 4 y 2 pacientes en cada grupo, respectivamente. Resultados: La variabilidad glucémica tanto del primer día (DS1) como la total de la estancia (DST) fue menor en aquellos pacientes tratados con el PIVBED frente al PIVBE: DS1 34,88 frente a 18,16 y DST 36,45 frente a 23,65 (p<0,001). Conclusión: Un protocolo de manejo de glucemia en pacientes críticos basado en escalas dinámicas disminuye la variabilidad glucémica (AU)

Objective: Glycemic variability is an independent predictor of mortality in critically ill patients. The objective of this study was to compare two intravenous insulin protocols in critically ill patients regarding the glycemic variability. Material and methods: This was a retrospective observational study performed by reviewing clinical records of patients from a Critical Care Unit for 4 consecutive months. First, a simpler Scale-Based Intravenous Insulin Protocol (SBIIP) was reviewed and later it was compared for the same months of the following year with a Sliding Scale-Based Intravenous Insulin Protocol (SSBIIP). All adult patients admitted to the unit during the referred months were included. Patients in whom the protocol was not adequately followed were excluded. A total of 557 patients were reviewed, of whom they had needed intravenous insulin 73 in the first group and 52 in the second group. Four and two patients were excluded in each group respectively. Results: Glycemic variability for both day 1 (DS1) and total stay (DST) was lower in SSBIIP patients compared to SBIIP patients: SD1 34.88 vs 18.16 and SDT 36.45 vs 23.65 (P<.001). Conclusion: A glycemic management protocol in critically ill patients based on sliding scales decreases glycemic variability (AU)

Broncoespasmo desencadenado por anestesia espinal. Informe de caso y revisión de la literatura / Bronchospasm triggered by spinal anaesthesia. Case report and review of the literature

Bronchospasm is a clinical condition that can occur unexpectedly during general anaesthesia, but is extremely rare after spinal anaesthesia. The following is a case presentation of a patient who developed bronchospasm after undergoing spinal anaesthesia not attributable to other causes, and that adds another case to the limited literature. Most publications allude to asthmatic patients, and this is probably the first description about a patient with emphysema-type COPD. Our case shows that although spinal anaesthesia is considered safe for patients with respiratory disease, specifically in asthmatic patients there is a possibility of bronchospasm in susceptible patients.

El broncoespasmo es una condición clínica que puede aparecer inesperadamente durante la anestesia general, pero es extremadamente rara tras la anestesia espinal. Presentamos un paciente que desarrolló broncoespasmo tras ser sometido a anestesia espinal, no atribuible a otras causas y que añade un caso más a la escasa literatura al respecto. La mayoría de las publicaciones se refieren a pacientes asmáticos, y esta sea probablemente la primera descripción en un paciente con EPOC tipo enfisematoso. Nuestro caso muestra que aunque la anestesia espinal se considere más segura para pacientes con patología respiratoria, en concreto en pacientes asmáticos, existe la posibilidad de que ésta produzca broncoespasmo en pacientes susceptibles.