Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
BMC Med Inform Decis Mak. 2010 Jan 25;10:5. doi: 10.1186/1472-6947-10-5.
Potassium disorders can cause major complications and must be avoided in critically ill patients. Regulation of potassium in the intensive care unit (ICU) requires potassium administration with frequent blood potassium measurements and subsequent adjustments of the amount of potassium administrated. The use of a potassium replacement protocol can improve potassium regulation. For safety and efficiency, computerized protocols appear to be superior over paper protocols. The aim of this study was to evaluate if a computerized potassium regulation protocol in the ICU improved potassium regulation.
In our surgical ICU (12 beds) and cardiothoracic ICU (14 beds) at a tertiary academic center, we implemented a nurse-centered computerized potassium protocol integrated with the pre-existent glucose control program called GRIP (Glucose Regulation in Intensive Care patients). Before implementation of the computerized protocol, potassium replacement was physician-driven. Potassium was delivered continuously either by central venous catheter or by gastric, duodenal or jejunal tube. After every potassium measurement, nurses received a recommendation for the potassium administration rate and the time to the next measurement. In this before-after study we evaluated potassium regulation with GRIP. The attitude of the nursing staff towards potassium regulation with computer support was measured with questionnaires.
The patient cohort consisted of 775 patients before and 1435 after the implementation of computerized potassium control. The number of patients with hypokalemia (<3.5 mmol/L) and hyperkalemia (>5.0 mmol/L) were recorded, as well as the time course of potassium levels after ICU admission. The incidence of hypokalemia and hyperkalemia was calculated. Median potassium-levels were similar in both study periods, but the level of potassium control improved: the incidence of hypokalemia decreased from 2.4% to 1.7% (P < 0.001) and hyperkalemia from 7.4% to 4.8% (P < 0.001). Nurses indicated that they considered computerized potassium control an improvement over previous practice.
Computerized potassium control, integrated with the nurse-centered GRIP program for glucose regulation, is effective and reduces the prevalence of hypo- and hyperkalemia in the ICU compared with physician-driven potassium regulation.
钾紊乱可导致严重并发症，必须在危重病患者中避免。重症监护病房（ICU）中的钾调节需要经常进行血钾测量，并根据测量结果调整钾的用量。使用钾替代方案可以改善钾调节。为了安全和效率，计算机化的方案似乎优于纸质方案。本研究旨在评估 ICU 中使用计算机化的钾调节方案是否可以改善钾调节。
在我们的三级学术中心的外科 ICU（12 张床）和心胸 ICU（14 张床）中，我们实施了一种以护士为中心的计算机化钾方案，该方案与称为 GRIP（重症监护患者血糖调节）的现有葡萄糖控制方案集成在一起。在实施计算机化方案之前，钾的补充由医生驱动。钾通过中央静脉导管或胃、十二指肠或空肠管连续给予。每次测量血钾后，护士都会收到钾给药速度和下一次测量时间的建议。在这项前后研究中，我们使用 GRIP 评估了钾调节。通过问卷调查评估了护理人员对计算机支持下钾调节的态度。
患者队列包括实施计算机化钾控制之前的 775 例患者和之后的 1435 例患者。记录了低钾血症（<3.5mmol/L）和高钾血症（>5.0mmol/L）患者的数量，以及 ICU 入院后血钾水平的时间过程。计算了低钾血症和高钾血症的发生率。两个研究期间的中位血钾水平相似，但钾控制水平有所改善：低钾血症的发生率从 2.4%降至 1.7%（P<0.001），高钾血症的发生率从 7.4%降至 4.8%（P<0.001）。护士表示，他们认为计算机化钾控制优于以前的实践。
与医生驱动的钾调节相比，与以护士为中心的 GRIP 程序（用于血糖调节）集成的计算机化钾控制可有效降低 ICU 中低钾血症和高钾血症的发生率。
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