Please cite this article in press as: Silveira, L.M., et al., Glycaemic variability in patients with severe sepsis or septic shock admitted to an Intensive Care Unit. Intensive Crit Care Nurs (2017), http://dx.doi.org/10.1016/j.iccn.2017.01.004 ARTICLE IN PRESS G Model YICCN-2491; No. of Pages 6 Intensive and Critical Care Nursing xxx (2017) xxx–xxx Contents lists available at ScienceDirect Intensive and Critical Care Nursing journal homepage: www.elsevier.com/iccn Glycaemic variability in patients with severe sepsis or septic shock admitted to an Intensive Care Unit  L.M. Silveira a,* , A. Basile-Filho b , E.A. Nicolini c , C.A.M. Dessotte e , G.C.S. Aguiar d , A.M. Stabile d,* a Fundamental Nursing Program, College of Nursing, University of São Paulo at Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil b Department of Surgery and Anatomy, Ribeirão Preto Medical School of the University of São Paulo, Ribeirão Preto, São Paulo, Brazil c Division of Intensive Care, Department of Surgery and Anatomy, Hospital of the Ribeirão Preto Medical School, Ribeirão Preto, São Paulo, Brazil d College of Nursing, University of São Paulo at Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil e Department of General and Specialized Nursing, College of Nursing, University of São Paulo at Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil a r t i c l e i n f o Article history: Received 27 June 2016 Received in revised form 19 December 2016 Accepted 7 January 2017 Keywords: Sepsis Unit care Sepsis shock Severe sepsis Glycaemic variability Glycaemic lability a b s t r a c t Background: Sepsis is associated with morbidity and mortality, which implies high costs to the global health system. Metabolic alterations that increase glycaemia and glycaemic variability occur during sepsis. Objective: To verify mean body glucose levels and glycaemic variability in Intensive Care Unit (ICU) patients with severe sepsis or septic shock. Method: Retrospective and exploratory study that involved collection of patients’ sociodemographic and clinical data and calculation of severity scores. Glycaemia measurements helped to determine glycaemic variability through standard deviation and mean amplitude of glycaemic excursions. Results: Analysis of 116 medical charts and 6730 glycaemia measurements revealed that the majority of patients were male and aged over 60 years. Surgical treatment was the main reason for ICU admission. High blood pressure and diabetes mellitus were the most usual comorbidities. Patients that died dur- ing the ICU stay presented the highest SOFA scores and mean glycaemia; they also experienced more hypoglycaemia events. Patients with diabetes had higher mean glycaemia, evaluated through standard deviation and mean amplitude of glycaemia excursions. Conclusion: Organic impairment at ICU admission may underlie glycaemic variability and lead to a less favourable outcome. High glycaemic variability in patients with diabetes indicates that monitoring of these individuals is crucial to ensure better outcomes. © 2017 Elsevier Ltd. All rights reserved. Implications for clinical practice • Glycaemic variability was related to death in septic patients, it is mandatory to prevent blood glucose variation in order to avoid further complications for the patient’s condition. • Glycaemic variability was greater among patients with diabetes compared with patients without diabetes. Considering the dam- age resulting from glycaemic variability, the diabetic patient  This work had no funding and the authors have no conflict of interest. This work was performed at Hospital of the Ribeirão Preto Medical School. * Corresponding authors at: Ribeirão Preto College of Nursing, Avenida Ban- deirantes, 3900, 1404-902, Brazil. E-mail addresses: lauramsilveira@yahoo.com.br (L.M. Silveira), angelita@eerp.usp.br (A.M. Stabile). should be monitored more closely, in order to avoid further com- plications arising from blood glucose variations. • Hypoglycemia appears to be more deleterious than hypergly- caemia. Therefore, in addition to preventing variation in blood glucose, it is also important to avoid hypoglycaemia. • Measures that aim to reduce glycaemic variability may not only impact on patient mortality and morbidity, but also reduce the length of ICU stay and the nursing workload. This would decrease the need for human and material resources and would have a favourable impact on hospital expenditure. Introduction Sepsis is a worrying condition associated with high morbid- ity and mortality, which implies high costs for health systems worldwide. Sepsis involves an inflammatory process that releases http://dx.doi.org/10.1016/j.iccn.2017.01.004 0964-3397/© 2017 Elsevier Ltd. All rights reserved.