Computer decision support software safely improves glycemic control in the burn intensive care unit: a randomized controlled clinical study.
Computer decision support software safely improves glycemic control in the burn intensive care unit: a randomized controlled clinical study.
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DOI：
10.1097/bcr.0b013e31820aaebf
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发表时间：
2011-03
期刊：
影响因子：
--
通讯作者：
Wade CE
中科院分区：
文献类型：
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作者：
Mann EA;Jones JA;Wolf SE;Wade CE
严重烧伤患者血糖控制的最佳方法尚不清楚。本随机对照研究的目的是确定计算机决策支持软件（CDSS）控制血糖浓度在烧伤重症监护病房的安全性和有效性。接受持续胰岛素输注的18名成人烧伤/创伤患者最初随机接受72小时的传统纸质方案（PP）或计算机方案（CP）血糖管理，然后交叉至替代方法，再持续72小时。目标血糖范围内的时间（80-110 mg/dl）在CP组中较高（47 ± 17% vs 41 ± 16.6%; p ≤ 0.05）; CP组超过目标范围的时间未显著缩短（49 ± 17.8% vs. 54 ± 17.1; p = 0.08）;在80 mg/dl目标范围下的时间方面没有观察到差异（CP 4.5 ± 2.8，PP 4.8 ± 3.3%; p = 0.8），低于60 mg/dl（p = 0.7）和低于40 mg/dl（p = 1.0）。CP组的严重低血糖事件（< 40 mg/dl）与未接受胰岛素治疗的患者的历史对照相比没有差异（p = 0.6）。CP组进行更多的血糖测量（p = 0.0003），护理人员对CP建议的依从性更高（p < 0.0001）。CDSS对危重烧伤病人血糖控制是安全有效的。目标范围内的时间改善，而低血糖事件未增加。CDSS增强了实践的一致性，为护理人员提供了标准化。
The optimal method for glycemic control in the critically burned patient is unknown. The purpose of this randomized controlled study was to determine the safety and efficacy of computer decision support software (CDSS) to control serum glucose concentration in a burn intensive care unit. Eighteen adult burn/trauma patients receiving continuous insulin infusion were initially randomized to receive glucose management via a traditional paper-based protocol (PP) or a computer protocol (CP) for 72 hours, then crossed over to the alternate method for an additional 72 hours. Time in target glucose range (80-110 mg/dl) was higher in the CP group (47 ± 17% versus 41 ± 16.6%; p ≤ 0.05); time over target range was not significantly reduced in the CP group (49 ± 17.8% versus 54 ± 17.1; p = 0.08); and no difference was noted in time under target range of 80 mg/dl (CP 4.5 ± 2.8, PP 4.8 ± 3.3%; p = 0.8), under 60 mg/dl (p = 0.7), and under 40 mg/dl (p = 1.0). Severe hypoglycemic events (< 40 mg/dl) did not differ from the CP group compared to historical controls for patients receiving no insulin (p = 0.6). More glucose measurements were performed in the CP group (p = 0.0003), and nursing staff compliance with CP recommendations was greater (p < 0.0001). Glycemic control using CDSS is safe and effective for the critically burned patient. Time in target range improved without increase in hypoglycemic events. CDSS enhanced consistency in practice, providing standardization among nursing staff.