Chima Ranjit S, Schoettker Pamela J, Varadarajan Kartik R, Kloppenborg Elizabeth, Hutson Tamara K, Brilli Richard J, Repaske David R, Seid Michael
Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA.
Qual Manag Health Care. 2012 Jan-Mar;21(1):20-8. doi: 10.1097/QMH.0b013e318241807c.
Hyperglycemia is common in critically ill children and appears to be associated with poor outcomes. However, the incidence of hypoglycemia while attempting glycemic control using an insulin infusion may be as high as 25% and hypoglycemia may be an independent risk factor for mortality in critically ill children.
An improvement team developed a guideline for initiation and maintenance of insulin infusions for hyperglycemia in critically ill, nondiabetic patients in the pediatric intensive care unit. The guideline included an insulin infusion algorithm that provided an initiating dose, titration instructions, and discontinuation parameters. Guideline recommendations addressed the frequency of bedside blood glucose monitoring and management of symptomatic hypoglycemia while on insulin infusion. The guideline was implemented in late January 2007 and revised in September 2007.
Hypoglycemic events in at-risk patients decreased significantly following implementation of the guideline, from 36% to 3%, despite an increase in the total number of patient days on insulin infusion. The average days between hypoglycemic events increased from 21 to 186.
Implementation of a guideline to manage critical illness hyperglycemia in nondiabetic, critically ill pediatric patients resulted in a reduction in hypoglycemic events and a sustained increase in the days between such events.
高血糖在危重症儿童中很常见，且似乎与不良预后相关。然而，在使用胰岛素输注进行血糖控制时，低血糖的发生率可能高达25%，并且低血糖可能是危重症儿童死亡的独立危险因素。
一个改进团队为儿科重症监护病房中患有高血糖的非糖尿病危重症患者制定了胰岛素输注起始和维持的指南。该指南包括一个胰岛素输注算法，提供起始剂量、滴定说明和停药参数。指南建议涉及床边血糖监测的频率以及胰岛素输注期间有症状低血糖的管理。该指南于2007年1月下旬实施，并于2007年9月修订。
尽管接受胰岛素输注的患者总天数增加，但在实施该指南后，高危患者的低血糖事件显著减少，从36%降至3%。低血糖事件之间的平均天数从21天增加到186天。
在非糖尿病危重症儿科患者中实施管理危重症高血糖的指南，导致低血糖事件减少，且此类事件之间的天数持续增加。
