Hosseini Dehkordi Seyed Hamed, Albu Jeanine, Aziz Emad F, Herzog Eyal
From the *Division of Internal Medicine, Icahn School of Medicine at Mount Sinai St. Luke's-West Hospital Center, New York, NY; †Division of Endocrinology, Icahn School of Medicine at Mount Sinai St. Luke's-West Hospital Center, New York, NY; ‡Division of Electrophysiology, Icahn School of Medicine at Mount Sinai St. Luke's-West Hospital Center, New York, NY; and §Cardiac Care Unit, Icahn School of Medicine at Mount Sinai St. Luke's Hospital. New York, NY.
Crit Pathw Cardiol. 2017 Dec;16(4):119-125. doi: 10.1097/HPC.0000000000000112.
Inpatient hyperglycemia has been associated with increased morbidity and mortality in critically ill patients. Optimal control of blood glucose (BG) levels using insulin infusion protocols has been shown to improve clinical outcomes. Protocols have been developed to prescribe a safe and effective rate of insulin infusion for optimal control of BG levels; however, a major obstacle in their implementation is their complexity. We have revised and updated our previously published pathway for the management of hyperglycemia, which introduces the "wheel" concept for insulin dosing. The "wheel" serves as a treatment guide. It is made up of 6 concentric circles. The core circle represents the goal of BG in critically ill patients, with inner circle showing the actual BG range of the patient. The 4 outer circles correspond to increasing rates of insulin infusion from tier 1 to tier 4. Simple guidelines are provided to facilitate conversion from insulin infusion to a subcutaneous insulin-delivery regimen in preparation for transfer from the cardiac care unit (CCU) setting. Our protocols also provide guidelines for management of diabetic ketoacidosis and hyperosmolar hyperglycemic states while at the same time creates a flowchart for activation of diabetes care team and their involvement in the multidisciplinary care of a patient in CCU with hyperglycemia and/or diabetes mellitus. This pathway provides a comprehensive and detailed, yet simple and practical algorithm for management of hyperglycemia in the CCU.
住院患者高血糖与危重症患者发病率和死亡率增加相关。使用胰岛素输注方案优化血糖（BG）水平已被证明可改善临床结局。已制定方案以规定安全有效的胰岛素输注速率，以优化BG水平控制；然而，其实施的一个主要障碍是其复杂性。我们修订并更新了我们之前发表的高血糖管理路径，该路径引入了胰岛素给药的“轮盘”概念。“轮盘”用作治疗指南。它由6个同心圆组成。核心圆圈代表危重症患者的BG目标，内圈显示患者的实际BG范围。4个外圈对应从1级到4级逐渐增加的胰岛素输注速率。提供了简单的指南，以便于在准备从心脏监护病房（CCU）转出时从胰岛素输注转换为皮下胰岛素给药方案。我们的方案还提供了糖尿病酮症酸中毒和高渗高血糖状态的管理指南，同时创建了一个流程图，用于激活糖尿病护理团队及其参与CCU中高血糖和/或糖尿病患者的多学科护理。该路径为CCU中高血糖的管理提供了一个全面、详细但又简单实用的算法。
