A pilot study of the SPRINT protocol for tight glycemic control in critically ill patients
A pilot study of the SPRINT protocol for tight glycemic control in critically ill patients
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DOI：
10.1089/dia.2006.8.449
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发表时间：
2006-08-01
影响因子：
5.4
通讯作者：
Wong, Xing-Wei
中科院分区：
文献类型：
--
作者：
Lonergan, Timothy;Le Compte, Aaron;Wong, Xing-Wei
背景：应激性高血糖在重症监护中很普遍，甚至在没有糖尿病病史的患者中也是如此。逆调节激素反应增加会增加糖异生和有效的胰岛素抵抗，药物治疗可能会加剧这一问题。已有研究表明，将血糖水平控制在4.06.1mmol.L范围内可降低死亡率，改善临床预后。专门的相对胰岛素和营养表(SPRINT)方案是一种简单的替代重症监护病房方案，用于调节胰岛素和营养输入，以获得严格的血糖控制在4.00-6.1mmo1/L的目标区间。这些查找表采用轮式格式，由护士根据每小时或每两小时的血糖测量以及营养和胰岛素给药率来确定血糖控制措施。方法：11名患者进行了一项先导性研究，包括使用Sprint方案进行2152小时的血糖水平控制。患者队列急性生理学和慢性健康状况评估11分平均为22分，高于以往胰岛素强化临床研究。结果：总体上，%的测量结果在4.0-6.1mmo1/L范围内，89%的测量结果在4.0-7.0 mmo1/L范围内，96%的测量结果在4.0-7.75mmo1/L范围内。平均血糖为5.8+/-0.9 mm ol/L，仅1.4%的测量结果小于4 mm o l/L，最小值为3.2 mm o l/L，最大值为11.8 m o l/L。结论：采用护理人员实施的血糖控制方案，无需医生干预或解释，可将血糖控制在预期范围内的最大时间。结果导致临床工作人员对SPRINT方案的高度支持，并接受了有效控制的频繁测量要求。该方案的易用性使临床工作人员的不遵从性降至最低。
Background: Stress-induced hyperglycemia is prevalent in critical care, even in patients with no history of diabetes. Increased counter-regulatory hormone response increases gluconeogenesis and effective insulin resistance, which can be exacerbated by drug therapy. Control of blood glucose levels to the 4.0-6.1 mmol/L range has been shown to reduce mortality and improve clinical outcomes. The Specialized Relative Insulin and Nutrition Tables (SPRINT) protocol is a simple alternative intensive care unit protocol for modulating insulin and nutritional input to gain tight blood glucose control in the 4.0-6.1 mmol/L target band. The look-up tables, implemented in a wheel-based format, are used by nurses to determine glycemic control actions based on hourly or 2-hourly blood glucose measurements and nutrition and insulin administration rates.Methods: An 11 patient pilot study was conducted comprising 2,152 hours of blood glucose level control using the SPRINT protocol. The patient cohort average Acute Physiology and Chronic Health Evaluation 11 score was 22, which was higher than previous intensive insulin clinical studies.Results: Overall, 64% of measurements were in the 4.0-6.1 mmol/L band, 89% in the 4.0-7.0 mmol/L band, and 96% of all measurements in the 4.0-7.75 mmol/L band. The average value was 5.8 +/- 0.9 mmol/L. Only 1.4% of all measurements were below 4 mmol/L, with a minimum of 3.2 mmol/L. The maximum value recorded was 11.8 mmol/L.Conclusions: Control of blood glucose level was achieved using a protocol implemented by the nursing staff without the need for physician intervention or interpretation, where control is defined as maximizing time within a desired band. The results led to a high level of support for the SPRINT protocol among clinical staff and acceptance of the frequent measurement requirement for effective control. The ease-of-use of the protocol resulted in minimal noncompliance by clinical staff.