The impact of intensive insulin protocols and restrictive blood transfusion strategies on glucose measurement in American Burn Association (ABA) verified burn centers.
The impact of intensive insulin protocols and restrictive blood transfusion strategies on glucose measurement in American Burn Association (ABA) verified burn centers.
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美国烧伤协会 (ABA) 验证的烧伤中心强化胰岛素方案和限制性输血策略对血糖测量的影响。
DOI：
10.1097/bcr.0b013e3181848c74
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发表时间：
2008
期刊：
影响因子：
--
通讯作者：
Wade,CharlesE
中科院分区：
文献类型：
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作者：
Mann,ElizabethA;Pidcoke,HeatherF;Salinas,Jose;Holcomb,JohnB;Wolf,StevenE;Wade,CharlesE
烧伤中心强化胰岛素和限制性血液使用方案的流行率尚不清楚，这可能是一个问题，因为这些治疗的综合影响是同时增加重症监护病房患者贫血和低血糖的流行率。这种发展是重要的，因为床旁（POC）血糖仪在低血细胞比容（HCT）的情况下错误地报告高值，可能掩盖低血糖的存在。我们假设大多数美国烧伤协会（阿坝）证实的烧伤中心已采用强化胰岛素治疗，同时限制输血可能增加低血糖的风险。联系了所有阿坝验证的烧伤中心（N = 44）。对强化胰岛素治疗、限制性输血和使用POC血糖仪的临床实践进行了评价。73%的阿坝中心实施了强化胰岛素方案（定义为血糖目标上限≤120 mg/dl），POC血糖仪测量几乎是普遍的; 95%的阿坝中心常规使用POC血糖仪。贫血在重症监护病房很普遍，并且由于最近的实践变化可能会增加。在84%的中心中，确定的血红蛋白和HCT水平触发输血，其中51%将输血限制为血红蛋白<7 g/dl或HCT <22%。大多数阿坝中心现在使用强化胰岛素方案，许多与限制性输血策略相结合。低血糖的高患病率与近乎普遍性贫血的结合是值得关注的，特别是在烧伤中心普遍使用血糖仪的情况下。
The prevalence of intensive insulin and restrictive blood use protocols in burn centers is unknown, which may be problematic as the combined impact of these therapies is to concomitantly increase the prevalence of anemia and hypoglycemia in intensive care unit patients. Such a development is important because point-of-care (POC) glucometers report erroneously high values in the presence of low hematocrit (HCT), potentially masking the presence of hypoglycemia. We hypothesized that most American Burn Association (ABA) verified burn centers have adopted intensive insulin therapy while simultaneously restricting blood transfusions potentially increasing risk of hypoglycemia. All ABA verified burn centers (N = 44) were contacted. Clinical practices regarding intensive insulin therapy, restrictive transfusion practices, and the use of POC glucometers were evaluated. Intensive insulin protocols were implemented at 73% of ABA centers (defined as upper glucose target of ≤120 mg/dl) and POC glucometers measurement was nearly universal; 95% of ABA centers use them routinely. Anemia is prevalent in intensive care units and may be increasing because of recent changes in practice. Defined hemoglobin and HCT levels trigger blood transfusion at 84% of centers, and of these, 51% restrict transfusion to hemoglobin <7 g/dl or HCT <22%. Most ABA centers now use intensive insulin protocols, many in combination with restrictive transfusion strategies. The combination of a higher prevalence of hypoglycemia in the presence of near universal anemia is concerning, particularly given the pervasiveness of glucometer use among burn centers.