Vogelzang Mathijs, Loef Bert G, Regtien Joost G, van der Horst Iwan C C, van Assen Hein, Zijlstra Felix, Nijsten Maarten W N
Department of Critical Care, University Medical Center, University of Groningen, 9700 RB, Groningen, The Netherlands.
Intensive Care Med. 2008 Aug;34(8):1421-7. doi: 10.1007/s00134-008-1091-y. Epub 2008 Apr 4.
Intensive insulin therapy is associated with the risk of hypoglycemia and increased costs of material and personnel. We therefore evaluated the safety and efficiency of a computer-assisted glucose control protocol in a large population of critically ill patients.
Observational cohort study in three intensive care units (32 beds) in a 1,300-bed university teaching hospital.
All 2,800 patients admitted to the surgical, neurosurgical, and cardiothoracic units; the study period started at each ICU after implementation of Glucose Regulation for Intensive Care Patients (GRIP), a freely available computer-assisted glucose control protocol.
We analysed compliance in relation to recommended insulin pump rates and glucose measurement frequency. Patients were on GRIP-ordered pump rates 97% of time. Median measurement time was 5min late (IQR 20min early to 34 min late). Hypoglycemia was uncommon (7% of patients for mild hypoglycemia, < 3.5mmol/l; 0.86% for severe hypoglycemia, < 2.2 mmol/l). Our predefined target range (4.0-7.5 mmol/l) was reached after a median of 5.6 h (IQR 0.2-11.8) and maintained for 89% (70-100%) of the remaining stay at the ICU. The number of measurements needed was 5.9 (4.8-7.3) per patient per day. In-hospital mortality was 10.1%.
Our computer-assisted glucose control protocol provides safe and efficient glucose regulation in routine intensive care practice. A low rate of hypoglycemic episodes was achieved with a considerably lower number of glucose measurements than used in most other schemes.
强化胰岛素治疗与低血糖风险以及材料和人员成本增加相关。因此，我们评估了一种计算机辅助血糖控制方案在大量重症患者中的安全性和有效性。
在一所拥有1300张床位的大学教学医院的三个重症监护病房（共32张床位）进行的观察性队列研究。
所有入住外科、神经外科和心胸外科病房的2800名患者；研究期在每个重症监护病房实施《重症监护患者血糖调节》（GRIP，一种免费的计算机辅助血糖控制方案）后开始。
我们分析了与推荐的胰岛素泵输注速率和血糖测量频率相关的依从性。患者97%的时间按照GRIP规定的泵输注速率。中位测量时间延迟了5分钟（四分位间距为提前20分钟至延迟34分钟）。低血糖情况不常见（轻度低血糖，血糖<3.5mmol/L，占患者的7%；严重低血糖，血糖<2.2mmol/L，占0.86%）。我们预先设定的目标范围（4.0 - 7.5mmol/L）在中位时间5.6小时（四分位间距0.2 - 11.8）后达到，并在重症监护病房剩余住院时间的89%（70 - 100%）内维持。每位患者每天所需的测量次数为5.9次（4.8 - 7.3次）。住院死亡率为10.1%。
我们的计算机辅助血糖控制方案在常规重症监护实践中提供了安全有效的血糖调节。低血糖事件发生率较低，且血糖测量次数比大多数其他方案少得多。
