Department of Surgery and Medicine, Children's Hospital, Boston, MA, USA.
Pediatr Crit Care Med. 2011 Nov;12(6):643-8. doi: 10.1097/PCC.0b013e31821926a5.
Tight glycemic control can potentially reduce morbidity and mortality in the intensive care unit but increases the risk of hypoglycemia. The most effective means to avoid hypoglycemia is to obtain frequent blood glucose samples, but this increases the burden to nursing staff. The objective of this study was to assess the ability of a real-time continuous glucose monitor to reduce hypoglycemia (blood glucose <60 mg/dL [3.3 mmol/L]) during standard care or tight glycemic control effected with a proportional integral derivative insulin titration algorithm.
Real-time continuous glucose monitor profiles obtained from an ongoing prospective randomized trial of tight glycemic control were retrospectively analyzed to determine whether the continuous glucose measure had prevented instances of hypoglycemia.
Cardiac intensive care unit.
Children 3 yrs of age or younger undergoing cardiac surgery were studied.
Intravenous insulin infusion and rescue glucose guided by the real-time continuous glucose monitor and the proportional integral derivative algorithm in the tight glycemic control arm (n = 155; target glucose 80-110 mg/dL [4.4-6.1 mmol/L]) and the real-time continuous glucose monitor in the standard care arm (n = 156).
No reduction in hypoglycemia was observed with real-time continuous glucose monitor alarms set at 60 mg/dL (3.3 mmol/L) (zero of 19 occurrences of blood glucose <60 mg/dL [3.3 mmol/L] detected); 18 of 40 subsequent incidences of hypoglycemia were detected after the alarm threshold was increased to 70 mg/dL (3.9 mmol/L). In the tight glycemic control arm, eight incidences were reduced in duration and an additional eight events were prevented with intravenous glucose. In the standard care arm, three of nine occurrences of hypoglycemia were detected with the duration reduced in all cases. On average, one to two false hypoglycemia alarms were observed in each patient.
The real-time continuous glucose monitor in combination with proportional integral derivative control can reduce hypoglycemia during tight glycemic control. The real-time continuous glucose monitor can also reduce hypoglycemia during standard care. However, false alarms increase the overall nursing workload.
严格的血糖控制有可能降低重症监护病房的发病率和死亡率，但会增加低血糖的风险。避免低血糖最有效的方法是频繁采集血糖样本，但这会增加护理人员的负担。本研究的目的是评估实时连续血糖监测在标准护理或使用比例积分微分胰岛素滴定算法进行严格血糖控制时，降低低血糖（血糖<60mg/dL[3.3mmol/L]）的能力。
回顾性分析正在进行的严格血糖控制前瞻性随机试验中获得的实时连续血糖监测谱，以确定连续血糖测量是否预防了低血糖事件。
心脏重症监护病房。
接受心脏手术的 3 岁或以下儿童。
在严格血糖控制组（n=155；目标血糖 80-110mg/dL[4.4-6.1mmol/L]）中，静脉胰岛素输注和由实时连续血糖监测和比例积分微分算法指导的抢救葡萄糖，以及在标准护理组（n=156）中，实时连续血糖监测。
实时连续血糖监测报警设置为 60mg/dL（3.3mmol/L）时，未观察到低血糖减少（零次检测到血糖<60mg/dL[3.3mmol/L]的发生）；将报警阈值增加到 70mg/dL（3.9mmol/L）后，检测到 40 次低血糖事件中的 18 次。在严格血糖控制组中，8 次低血糖事件的持续时间缩短，另外 8 次事件通过静脉葡萄糖得到预防。在标准护理组中，9 次低血糖事件中的 3 次被检测到，所有情况下持续时间均缩短。平均每个患者观察到 1-2 次假低血糖报警。
实时连续血糖监测与比例积分微分控制相结合可减少严格血糖控制期间的低血糖。实时连续血糖监测还可以在标准护理期间减少低血糖。然而，假警报会增加整体护理工作量。
