Hirshberg Eliotte, Lacroix Jaques, Sward Kathy, Willson Douglas, Morris Alan H
University of Utah, Salt Lake City, UT.
Université de Montréal, Montréal, QC, Canada.
Chest. 2008 Jun;133(6):1328-1335. doi: 10.1378/chest.07-2702. Epub 2008 Mar 13.
We document clinicians' stated blood glucose control practice patterns in North American pediatric and adult ICUs.
Using a Web-based self-administered questionnaire, we conducted a nationwide survey of North American pediatric and adult ICUs. Participants included ICU medical directors, nurses, fellows in training, and attending intensivists from participating ICUs in three critical care research networks.
Item generation and item selection were performed according to standard scientific survey methods. Questions were designed to describe clinicians' perceptions about glucose control practices. The questionnaire topics included the following: respondent characteristics; ICU description; hyperglycemia; hypoglycemia; and glucose measurement. The institutional response rate was 96% (50 of 52 institutions). The clinician response rate was 58% (163 of 282 physicians). Adult ICU clinicians defined hyperglycemia (120 mg/dL [6.2 mmol/L]) at a lower threshold than pediatric ICU clinicians (150 mg/dL [8.3 mmol/L]). Hypoglycemia was defined similarly by both groups (median, < or = 60 mg/dL [3.3 mmol/L]; range, 40 to 80 mg/dL [2.2 to 4.4 mmol/L]). More pediatric ICU clinicians (84.5%) than adult ICU clinicians (59.1%) considered hypoglycemia to be more dangerous than hyperglycemia. A larger percentage of adult ICU clinicians (82.5%) than pediatric ICU clinicians (49.3%) preferred a target blood glucose level between 80 and 110 mg/dL (4.4 to 6.1 mmol/L). Clinical algorithms for glucose management varied among clinicians and across institutions.
Blood glucose control with insulin is used frequently for critically ill adults and children. A wide variation in practice exists in blood glucose targets, hyperglycemia and hypoglycemia definitions, and decision algorithms among North American adult and pediatric ICUs.
我们记录北美儿科和成人重症监护病房（ICU）临床医生所述的血糖控制实践模式。
我们通过基于网络的自填问卷，对北美儿科和成人ICU进行了一项全国性调查。参与者包括来自三个重症监护研究网络中参与ICU的ICU医疗主任、护士、进修医生和主治重症监护医生。
根据标准科学调查方法进行条目生成和条目选择。问题旨在描述临床医生对血糖控制实践的看法。问卷主题包括以下方面：受访者特征；ICU描述；高血糖；低血糖；以及血糖测量。机构回复率为96%（52家机构中的50家）。临床医生回复率为58%（282名医生中的163名）。成人ICU临床医生定义高血糖的阈值（120 mg/dL [6.2 mmol/L]）低于儿科ICU临床医生（150 mg/dL [8.3 mmol/L]）。两组对低血糖的定义相似（中位数，≤60 mg/dL [3.3 mmol/L]；范围，40至80 mg/dL [2.2至4.4 mmol/L]）。认为低血糖比高血糖更危险的儿科ICU临床医生（84.5%）多于成人ICU临床医生（59.1%）。偏好目标血糖水平在80至110 mg/dL（4.4至6.1 mmol/L）之间的成人ICU临床医生（82.5%）比例高于儿科ICU临床医生（49.3%）。临床医生之间以及不同机构的血糖管理临床算法各不相同。
胰岛素用于危重症成人和儿童的血糖控制很常见。北美成人和儿科ICU在血糖目标、高血糖和低血糖定义以及决策算法方面存在广泛的实践差异。
