Guidelines for the use of an insulin infusion for the management of hyperglycemia in critically ill patients
Guidelines for the use of an insulin infusion for the management of hyperglycemia in critically ill patients
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DOI：
10.1097/ccm.0b013e3182653269
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发表时间：
2012-12-01
影响因子：
8.8
通讯作者：
Schunemann, Holger
中科院分区：
文献类型：
--
作者：
Jacobi, Judith;Bircher, Nicholas;Schunemann, Holger
目的：评估文献并确定胰岛素治疗的重要方面，以促进安全有效的输注治疗以达到明确的血糖终点。方法：在可能的情况下，使用推荐等级、评估、开发和评估（GRADE）方法对文献进行评估，以评估胰岛素输注对普通重症监护病房患者以及神经损伤、创伤性损伤和心血管手术特定亚组患者结局的影响。通过文献回顾和专家意见确定了有助于安全有效的胰岛素输注治疗的要素。大多数支持危重患者使用胰岛素输注治疗的文献缺乏足够的力度来支持弱建议（称为建议），因此给定干预措施的理想效果和不良效果之间的差异并不总是很清楚。 建议：本文重点关注建议的血糖控制终点，即血糖 >= 150 mg/dL 触发干预措施以将血糖维持在该水平以下且绝对 < 180 mg/dL。通过此治疗终点，普通重症监护病房患者的死亡率略有降低，围手术期患者、心脏手术术后患者、创伤后患者和神经损伤患者的发病率也有所降低。我们建议胰岛素治疗方案和监测系统的设计应避免和检测低血糖（血糖）
Objective: To evaluate the literature and identify important aspects of insulin therapy that facilitate safe and effective infusion therapy for a defined glycemic end point.Methods: Where available, the literature was evaluated using Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) methodology to assess the impact of insulin infusions on outcome for general intensive care unit patients and those in specific subsets of neurologic injury, traumatic injury, and cardiovascular surgery. Elements that contribute to safe and effective insulin infusion therapy were determined through literature review and expert opinion. The majority of the literature supporting the use of insulin infusion therapy for critically ill patients lacks adequate strength to support more than weak recommendations, termed suggestions, such that the difference between desirable and undesirable effect of a given intervention is not always clear.Recommendations: The article is focused on a suggested glycemic control end point such that a blood glucose >= 150 mg/dL triggers interventions to maintain blood glucose below that level and absolutely < 180 mg/dL. There is a slight reduction in mortality with this treatment end point for general intensive care unit patients and reductions in morbidity for perioperative patients, postoperative cardiac surgery patients, post-traumatic injury patients, and neurologic injury patients. We suggest that the insulin regimen and monitoring system be designed to avoid and detect hypoglycemia (blood glucose