A replicable method for blood glucose control in critically patients
A replicable method for blood glucose control in critically patients
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DOI：
10.1097/ccm.0b013e3181743a5a
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发表时间：
2008-06-01
影响因子：
8.8
通讯作者：
Warner, Homer
中科院分区：
文献类型：
--
作者：
Morris, Alan H.;Orme, James, Jr.;Warner, Homer
上下文。为了确保临床实验的可解释性和可重复性，方法必须足够明确，并应引起遵守研究方案的不同临床医生做出相同的决定。本研究的目的是确定临床医生对方案建议的依从性是否超过90%。设计：我们制定了一个足够明确的计算机方案（eProtocol-insulin）来管理危重成人患者的血糖。我们监测了四家医院的四家重症监护病房的临床医生对电子方案-胰岛素推荐的依从性，并将血糖分布与一家医院的简单临床指南和另一家医院的纸质方案进行了比较。所有方案和指南均使用静脉注射胰岛素和80 - 110 mg/dL （4.4-6.1 mmol/L）血糖目标。环境：本研究的环境为四所专科医院重症监护病房。这项研究包括需要静脉注射胰岛素的危重成人。本研究中使用的干预措施是床边电脑控制血糖。主要结果测量。主要结局指标是临床医生对eprotocol -胰岛素建议的依从性。结果：4个重症监护病房患者31 ~ 458例，血糖测量2226 ~ 19925例。临床医生对eprotocol -胰岛素推荐的依从性为91% ~ 98%。四家医院的血糖分布相似（广义线性模型p =.18）。与简单指南相比，eprotocoli -胰岛素血糖在目标范围内的测量值从21%增加到39%，平均血糖从142降至115 mg/dL(广义线性模型p
Context. To ensure interpretability and replicability of clinical experiments, methods must be adequately explicit and should elicit the same decision from different clinicians who comply with the study protocol.Objective. The objective of this study was to determine whether clinician compliance with protocol recommendations exceeds 90%.Design: We developed an adequately explicit computerized protocol (eProtocol-insulin) for managing critically ill adult patient blood glucose. We monitored clinician compliance with eProtocol-insulin recommendations in four intensive care units in four hospitals and compared blood glucose distributions with those of a simple clinical guideline at one hospital and a paper-based protocol at another. All protocols and the guideline used intravenous insulin and 80 to 110 mg/dL (4.4-6.1 mmol/L) blood glucose targets.Setting: The setting for this study was four academic hospital intensive care units.Patients. This study included critically ill adults requiring intravenous insulin.Intervention. Intervention used in this study was a bedside computerized protocol for managing blood glucose.Main Outcome Measure. The main outcome measure was clinician compliance with eProtocol-insulin recommendations.Results: The number of patients was 31 to 458 and the number of blood glucose measurements was 2,226 to 19,925 among the four intensive care units. Clinician compliance with eProtocol-insulin recommendations was 91% to 98%. Blood glucose distributions were similar in the four hospitals (generalized linear model p =.18). Compared with the simple guideline, eProtocol-insulin glucose measurements within target increased from 21% to 39%, and mean blood glucose decreased from 142 to 115 mg/dL (generalized linear model p