Computerization of the Yale Insulin Infusion Protocol and Potential Insights into Causes of Hypoglycemia with Intravenous Insulin
Computerization of the Yale Insulin Infusion Protocol and Potential Insights into Causes of Hypoglycemia with Intravenous Insulin
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DOI：
10.1089/dia.2012.0277
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发表时间：
2013-03-01
影响因子：
5.4
通讯作者：
Besterman, Brian J.
中科院分区：
文献类型：
--
作者：
Marvin, Michael R.;Inzucchi, Silvio E.;Besterman, Brian J.
背景：重症监护室（ICU）中危重高血糖患者的管理一直充满争议。只有一项随机试验证明了强化血糖控制的死亡率获益，所有后续研究均未能证实这一获益，并显示强化治疗患者发生严重低血糖（SH）的风险显著增加。在大多数这些试验中，遵守协议既不跟踪，也不reported.Methods：一个回顾性分析的所有患者入院的ICU谁是治疗与胰岛素输注直接由GlucoCare（TM）IGC系统，FDA批准的胰岛素剂量计算器（耶鲁100-140 mg/dL协议）。平均血糖（BG）水平、达到目标范围的时间和SH的发生率（1，657例患者的55，000个读数，SH的总发生率为读数的0.01%和患者的0.3%。1.1%的读数和17.6%的患者发生MH。MH的主要潜在原因是：（1）方案指导的建议，包括继续使用胰岛素和BG
Background: The management of critically ill hyperglycemic patients in the intensive care unit (ICU) has been fraught with recent controversy. Only one randomized trial has demonstrated a mortality benefit to intensive glycemic control, with all subsequent studies failing to confirm this benefit and revealing a markedly increased risk of severe hypoglycemia (SH) in intensively treated patients. In most of these trials, adherence to the protocols were neither tracked nor reported.Methods: A retrospective analysis of all patients admitted to an ICU who were treated with an insulin infusion directed by the GlucoCare (TM) IGC System, an FDA-cleared insulin-dosing calculator (Yale 100-140 mg/dL protocol). Mean blood glucose (BG) levels, time to target range and incidence of SH (55,000 readings in 1,657 patients, overall incidence of SH was 0.01% of readings and 0.3% of patients. MH occurred in 1.1% of readings and 17.6% of patients. The top potential causes of MH were: (1) Protocol-directed recommendations including continuation of insulin with BG