Goldberg Philip A, Siegel Mark D, Sherwin Robert S, Halickman Joshua I, Lee Michelle, Bailey Valerie A, Lee Sandy L, Dziura James D, Inzucchi Silvio E
Department of Internal Medicine, Section of Endocrinology, Yale New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut 06520, USA.
Diabetes Care. 2004 Feb;27(2):461-7. doi: 10.2337/diacare.27.2.461.
In a recent randomized controlled trial, lowering blood glucose levels to 80-110 mg/dl improved clinical outcomes in critically ill patients. In that study, the insulin infusion protocol (IIP) used to normalize blood glucose levels provided valuable guidelines for adjusting insulin therapy. In our hands, however, ongoing expert supervision was required to effectively manage the insulin infusions. This work describes our early experience with a safe, effective, nurse-implemented IIP that provides detailed insulin dosing instructions and requires minimal physician input.
We collected data from 52 medical intensive care unit (MICU) patients who were placed on the IIP. Blood glucose levels were the primary outcome measurement. Relevant clinical variables and insulin requirements were also recorded. MICU nurses were surveyed regarding their experience with the IIP.
To date, our IIP has been employed 69 times in 52 patients admitted to an MICU. Using the IIP, the median time to reach target blood glucose levels (100-139 mg/dl) was 9 h. Once blood glucose levels fell below 140 mg/dl, 52% of 5,808 subsequent hourly blood glucose values fell within our narrow target range; 66% within a "clinically desirable" range of 80-139 mg/dl; and 93% within a "clinically acceptable" range of 80-199 mg/dl. Only 20 (0.3%) blood glucose values were <60 mg/dl, none of which resulted in clinically significant adverse events. In general, the IIP was readily accepted by our MICU nursing staff, most of whom rated the protocol as both clinically effective and easy to use.
Our nurse-implemented IIP is safe and effective in improving glycemic control in critically ill patients.
在最近一项随机对照试验中，将血糖水平降至80 - 110mg/dl可改善重症患者的临床结局。在该研究中，用于使血糖水平正常化的胰岛素输注方案（IIP）为调整胰岛素治疗提供了有价值的指导。然而，在我们实际操作中，需要持续的专家监督才能有效管理胰岛素输注。本研究描述了我们在一种安全、有效的由护士实施的IIP方面的早期经验，该方案提供了详细的胰岛素给药说明，且只需医生极少的参与。
我们收集了52例接受IIP治疗的医学重症监护病房（MICU）患者的数据。血糖水平是主要的结局指标。还记录了相关的临床变量和胰岛素需求情况。对MICU护士就其使用IIP的经验进行了调查。
迄今为止，我们的IIP已在52例入住MICU的患者中使用了69次。使用IIP时，达到目标血糖水平（100 - 139mg/dl）的中位时间为9小时。一旦血糖水平降至140mg/dl以下，在随后的5808次每小时血糖值中，52%落在我们设定的狭窄目标范围内；66%落在“临床理想”范围80 - 139mg/dl内；93%落在“临床可接受”范围80 - 199mg/dl内。只有20个（0.3%）血糖值<60mg/dl，且均未导致具有临床意义的不良事件。总体而言，我们的MICU护理人员很容易接受IIP，他们中的大多数人认为该方案在临床上有效且易于使用。
我们由护士实施的IIP在改善重症患者血糖控制方面是安全有效的。
