Artículo hiperglucemia publicado en CRITICAL CARE
Ethics Committees that approved the study at each institution.
- Comité Etico de Investigación Clínica. (Ethics in Clinical Investigation Committee) Hospital Clínico Universitario, Valencia, Spain. (REF:39/09)
- Comité Etico de Investigación Clínica. (Ethics in Clinical Investigation Committee) Hospital Universitario 12 de Octubre, Madrid, Spain. (REF: 09/227)
- Comité Etico de Investigación Clínica. (Ethics in Clinical Investigation Committee) Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain (REF: IR2009)
- Comité Etico de Investigación Clínica. (Ethics in Clinical Investigation Committee) Hospital Virgen de las Nieves, Granada, Spain. (REF: 18/18/2009)
- Comité Etico de Investigación Clínica de Euskadi. (Ethics in Clinical Investigation Committee) Vitoria-Gasteizt. Spain. (REF:02/02/2010)
- Comité Etico de Investigación Clínica. (Ethics in Clinical Investigation Committee) Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain. (REF: PR239/09)
- Comité Etico de Investigación Clínica. (Ethics in Clinical Investigation Committee) Hospital General Universitario, Alicante, Spain. (REF:2009/63)
- Comité Etico de Investigación Clínica. (Ethics in Clinical Investigation Committee) Hospital Clínico San Carlos, Madrid, Spain. (REF:09/351)
- Comité Etico de Investigación Clínica. (Ethics in Clinical Investigation Committee) Hospital General Universitario Reina Sofía, Murcia, Spain. (REF:14/12/2009)
Table S1 Insulin therapy protocol
A.- Target: Capillary glycemia (CG) 110-150 mg/dl.
B.- Insulin pump: 50 IU of standard insulin in 50 ml of physiological saline.
C.- Steps:
- Determine baseline CG
- Start insulin administration according to starting regimen
- Simultaneously start enteral nutrition
- Determine CG every hour to adjust infusion rate to starting regimen. After the third hour, change to maintenance regimen.
D.- Interruption of enteral nutrition: if for any reason nutrition is stopped, simultaneously close off the insulin pump and continue CG determinations every hour until at least a total of three. Assessment by responsible physician.
E.- Insulin therapy withheld for > 24 hours:because CG is in the normal range (110-150 mg/dL); determinations every 6 hours until > 150 mg/dl, from which point therapy is resumed at 1 ml/h following the maintenance regimen. If the target glucose level is maintained after 48 h of withholding therapy, it should be interrupted indefinitely.
F.-Starting regimen:

G.- Maintenance regimen:
- Determine CG every 4 h if stable. Switch to every hour following any modification.
- CG 110-150 mg/dl: do not modify infusion rate.
- CG >30 mg/dl higher than the previous reading: increase infusion rate by 1 ml/h.
- CG 1-29 mg/dl higher than the previous reading: increase infusion rate by 0.5 ml/h.
- CG >30 mg/dl lower than the previous reading: reduce by 1 ml/h only if CG is < 180 mg/dl. Do not modify if CG is > 180 mg/dl.
- CG 1-29 mg/dl lower than the previous reading: reduce by 0.5 ml/h only if CG is < 180 mg/dl. Do not modify if CG is > 180 mg/dl.
- CG <110 mg/dl: stop infusion until CG is > 150 mg/dl, restart at 1 ml/h and continue adjustments according to maintenance regimen.
- CG 50-80 mg/dL: stop infusion, administer 20 ml of glucose 33% and alert responsible physician. If CG is <50 mg/dL, stop infusion, administer 40 ml of glucose 33% and alert responsible physician. Take CG readings every 15 min until equal to or higher than 80 mg/dL.

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