Blacklaws Emily, Shah Kieran, Stabler Sarah N
, BSc, PharmD, was, at the time of this study, a student in the Entry-to-Practice PharmD program, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia. She has now graduated and is currently a Year 1 pharmacy resident with Lower Mainland Pharmacy Services in British Columbia.
, BSc(Pharm), ACPR, PharmD, is a Clinical Pharmacy Specialist (Critical Care), Surrey Memorial Hospital, Surrey, British Columbia.
Can J Hosp Pharm. 2024 Oct 9;77(4):e3553. doi: 10.4212/cjhp.3553. eCollection 2024.
Emerging evidence describes the high incidence and strong impact of hyperglycemia on the outcomes of critically ill patients with a diagnosis of COVID-19. Given resource limitations during the COVID-19 pandemic, clinicians moved away from using continuous IV infusions of insulin to manage hyperglycemia.
To evaluate glycemic control in critically ill patients receiving various medication regimens to manage their hyperglycemia.
This retrospective cohort study involved 120 mechanically ventilated adult patients (> 18 years) with COVID-19 who were admitted to the intensive care unit (ICU) between February 2020 and December 2021. The following data were collected for the first 14 days of the ICU admission: blood glucose values (up to 4 times daily), hypoglycemia events, and antihyperglycemic medication regimens.
The use of IV insulin infusions maintained glucose measurements within the target range of 4 to 10 mmol/L more often than any other medication regimen, with 60% of measured values falling within the target range. The use of a sliding-scale insulin regimen maintained 52% of glucose measurements within the target range. Oral hypoglycemic agents performed relatively poorly, with only 12% to 29% of glucose measurements within range. The coadministration of corticosteroids led to worse glycemic control across all medication regimens.
This study confirmed that ICUs should continue using the standard protocol of IV insulin infusion to achieve recommended blood glucose targets in critically ill patients with COVID-19, particularly those receiving corticosteroids.
新出现的证据表明，高血糖在确诊为COVID-19的重症患者的预后中具有高发病率和强烈影响。鉴于COVID-19大流行期间的资源限制，临床医生不再使用胰岛素持续静脉输注来管理高血糖。
评估接受各种药物治疗方案来管理高血糖的重症患者的血糖控制情况。
这项回顾性队列研究纳入了2020年2月至2021年12月期间入住重症监护病房（ICU）的120例机械通气的成年COVID-19患者（年龄>18岁）。在入住ICU的前14天收集以下数据：血糖值（每天最多4次）、低血糖事件和降糖药物治疗方案。
与任何其他药物治疗方案相比，静脉输注胰岛素更常将血糖测量值维持在4至10 mmol/L的目标范围内，60%的测量值落在目标范围内。采用胰岛素强化治疗方案时，52%的血糖测量值维持在目标范围内。口服降糖药的效果相对较差，只有12%至29%的血糖测量值在范围内。在所有药物治疗方案中，同时使用皮质类固醇会导致血糖控制更差。
本研究证实，ICU应继续采用静脉输注胰岛素的标准方案，以在COVID-19重症患者中实现推荐的血糖目标，尤其是那些正在接受皮质类固醇治疗的患者。
