Reduction in hypoglycemic events in critically ill patients on continuous insulin following implementation of a treatment guideline.
Reduction in hypoglycemic events in critically ill patients on continuous insulin following implementation of a treatment guideline.
复制标题
实施治疗指南后，使用连续胰岛素治疗的危重患者的低血糖事件减少。
DOI：
10.1097/qmh.0b013e318241807c
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发表时间：
2012
影响因子：
1.2
通讯作者：
Seid,Michael
中科院分区：
文献类型：
--
作者：
Chima,RanjitS;Schoettker,PamelaJ;Varadarajan,KartikR;Kloppenborg,Elizabeth;Hutson,TamaraK;Brilli,RichardJ;Repaske,DavidR;Seid,Michael
背景：高血糖在危重儿童中很常见，而且似乎与不良预后有关。然而，在尝试使用胰岛素输注控制血糖时，低血糖的发生率可能高达25%，低血糖可能是危重儿童死亡的独立危险因素。方法：一个改进小组制定了一项指南，用于在儿科重症监护病房的危重非糖尿病患者中开始和维持胰岛素输注治疗高血糖。该指南包括胰岛素输注算法，该算法提供了起始剂量、滴定说明和停用参数。指南建议涉及胰岛素输注时床边血糖监测和症状性低血糖的处理频率。该指南于2007年1月下旬实施，并于2007年9月修订。结果：实施指南后，高危患者的低血糖事件显著减少，从36%降至3%，尽管胰岛素输注患者的总天数增加。低血糖事件之间的平均间隔天数从21天增加到186天。结论：在非糖尿病、重症儿科患者中实施管理危重疾病高血糖的指南后，低血糖事件的发生减少，而此类事件之间的天数持续增加。
Background: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.Methods: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.Results: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.Conclusions: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.