Implementation and evaluation of the SPRINT protocol for tight glycaemic control in critically ill patients: a clinical practice change.
Implementation and evaluation of the SPRINT protocol for tight glycaemic control in critically ill patients: a clinical practice change.
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DOI：
10.1186/cc6868
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发表时间：
2008
期刊：
影响因子：
--
通讯作者：
Hann C
中科院分区：
文献类型：
--
作者：
Chase JG;Shaw G;Le Compte A;Lonergan T;Willacy M;Wong XW;Lin J;Lotz T;Lee D;Hann C
应激性高血压在重症监护中很常见。将血糖水平控制在4.4至6.1 mmol/L范围内或低于7.75 mmol/L可降低死亡率并改善临床结局。专业相对胰岛素营养表（SPRINT）方案是一种简单的基于轮的系统，可调节胰岛素和营养输入，以实现严格的血糖控制。SPRINT是在普通重症监护室（ICU）中实施的临床实践变更。本研究的目的是测量与以前的ICU控制方法相比，SPRINT方案对血液病控制和死亡率的影响。将371例中位急性生理学和慢性健康评估（APACHE）II评分为18（四分位数间距[IQR] 15至24）的SPRINT患者的血糖控制和死亡率结局与413例中位APACHE II评分为18（IQR 15至23）的回顾性队列进行比较。总体而言，53.9%的测量值处于4.4至6.1 mmol/L范围内。发现血糖浓度呈对数正态分布，因此始终使用对数正态统计来描述数据。平均对数正态分布血药浓度为6.0 mmol/L（标准差1.5 mmol/L）。所有测量值中只有9.0%低于4.4 mmol/L，3.8%低于4 mmol/L，0.1%低于2.2 mmol/L。在SPRINT上，与回顾性对照相比，80%以上的测量值在4.4至6.1 mmol/L范围内，血糖标准差低38%。SPRINT患者血糖范围和峰值与死亡率无相关性（P >0.30）。对于ICU住院时间（LoS）大于或等于3天，住院死亡率从34.1%降至25.4%（-26%）（P = 0.05）。对于ICU LoS大于或等于4天，住院死亡率从34.3%降至23.5%（-32%）（P = 0.02）。对于ICU LoS大于或等于5天，住院死亡率从31.9%降至20.6%（-35%）（P = 0.02）。ICU死亡率也降低，但P值小于0.13，ICU LoS大于或等于4和5天。SPRINT在重症危重队列人群中实现了高水平的血液病控制。与回顾性高血压队列相比，观察到死亡率降低。范围和峰值血糖指标不再与SPRINT下的死亡率结局相关。
Stress-induced hyperglycaemia is prevalent in critical care. Control of blood glucose levels to within a 4.4 to 6.1 mmol/L range or below 7.75 mmol/L can reduce mortality and improve clinical outcomes. The Specialised Relative Insulin Nutrition Tables (SPRINT) protocol is a simple wheel-based system that modulates insulin and nutritional inputs for tight glycaemic control. SPRINT was implemented as a clinical practice change in a general intensive care unit (ICU). The objective of this study was to measure the effect of the SPRINT protocol on glycaemic control and mortality compared with previous ICU control methods. Glycaemic control and mortality outcomes for 371 SPRINT patients with a median Acute Physiology And Chronic Health Evaluation (APACHE) II score of 18 (interquartile range [IQR] 15 to 24) are compared with a 413-patient retrospective cohort with a median APACHE II score of 18 (IQR 15 to 23). Overall, 53.9% of all measurements were in the 4.4 to 6.1 mmol/L band. Blood glucose concentrations were found to be log-normal and thus log-normal statistics are used throughout to describe the data. The average log-normal glycaemia was 6.0 mmol/L (standard deviation 1.5 mmol/L). Only 9.0% of all measurements were below 4.4 mmol/L, with 3.8% below 4 mmol/L and 0.1% of measurements below 2.2 mmol/L. On SPRINT, 80% more measurements were in the 4.4 to 6.1 mmol/L band and standard deviation of blood glucose was 38% lower compared with the retrospective control. The range and peak of blood glucose were not correlated with mortality for SPRINT patients (P >0.30). For ICU length of stay (LoS) of greater than or equal to 3 days, hospital mortality was reduced from 34.1% to 25.4% (-26%) (P = 0.05). For ICU LoS of greater than or equal to 4 days, hospital mortality was reduced from 34.3% to 23.5% (-32%) (P = 0.02). For ICU LoS of greater than or equal to 5 days, hospital mortality was reduced from 31.9% to 20.6% (-35%) (P = 0.02). ICU mortality was also reduced but the P value was less than 0.13 for ICU LoS of greater than or equal to 4 and 5 days. SPRINT achieved a high level of glycaemic control on a severely ill critical cohort population. Reductions in mortality were observed compared with a retrospective hyperglycaemic cohort. Range and peak blood glucose metrics were no longer correlated with mortality outcome under SPRINT.
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影响因子：
8.8
作者：
Egi, Moritoki;Bellomo, Rinaldo;Stow, Peter
通讯作者：
Stow, Peter
影响因子：
1.5
作者：
Chee, F;Fernando, T;van Heerden, PV
通讯作者：
van Heerden, PV
影响因子：
5.4
作者：
Lotz, Thomas F.;Chase, J. Geoffrey;Mann, Jim I.
通讯作者：
Mann, Jim I.
影响因子：
8.9
作者：
Krinsley, JS
通讯作者：
Krinsley, JS
影响因子：
9.6
作者：
Krinsley, JS;Jones, RL
通讯作者：
Jones, RL