- 期刊
Blood Glucose Control in Critically Ill Patients Using a Titrated Protocol in An Intensive Care Unit
以持續性靜脈胰島素注射在重症病人的血糖控制
摘要
Background: Intensive blood sugar control is important in critically ill patients, but, in our experience, this is difficult to be performed, especial when using the traditional sliding-scale intravenous insulin infusion (IVII). Objective: To maintain blood sugar within a range of 81 mg/dl to 200 mg/dl in critically ill patients with an improvement in outcome. Design: Combined retrospective-prospective before-after cohort study. Setting: Thirty-bed medical ICU in a medical center. Patients: Two cohorts of 30 consecutive ICU patients with poor blood sugar control and requiring insulin infusion. Methods: Patients in the control cohort received insulin infusions adjusted according to target blood glucose ranges and sliding scales at the physicians discretion. Patients in the study cohort received an insulin infusion titrated using a standardized protocol targeting a blood glucose level of 81-200 mg/dl. Measurements and results: Efficiency was measured by comparing the time spent within the target range between cohorts, and the days needed for IVII. Safety was assessed by comparing the incidence of hypoglycemia (＜60 mg/dl) and complication of hypoglycemia, such as seizure, change in consciousness, and cold sweating. Patients in the study cohort maintained their blood glucose within the target range longer (14.1±7.0 vs 9.3±6.1 h/day; p＜0.001) than the controls. The duration of IVII was shorter in the study cohort (5.9±4.3 vs 11.9±7.4 days; p＜0.001) than in the controls. More hypoglycemia was noted in the study cohort, but there were no clinical symptoms of hypoglycemia. Conclusions: Standardization of IVII with titration improves the efficiency of glycemic control in critically ill adults. The traditional sliding-scale IVII used in Taiwan has less glycemic control efficiency in critically ill patient.
並列摘要
Background: Intensive blood sugar control is important in critically ill patients, but, in our experience, this is difficult to be performed, especial when using the traditional sliding-scale intravenous insulin infusion (IVII). Objective: To maintain blood sugar within a range of 81 mg/dl to 200 mg/dl in critically ill patients with an improvement in outcome. Design: Combined retrospective-prospective before-after cohort study. Setting: Thirty-bed medical ICU in a medical center. Patients: Two cohorts of 30 consecutive ICU patients with poor blood sugar control and requiring insulin infusion. Methods: Patients in the control cohort received insulin infusions adjusted according to target blood glucose ranges and sliding scales at the physicians discretion. Patients in the study cohort received an insulin infusion titrated using a standardized protocol targeting a blood glucose level of 81-200 mg/dl. Measurements and results: Efficiency was measured by comparing the time spent within the target range between cohorts, and the days needed for IVII. Safety was assessed by comparing the incidence of hypoglycemia (＜60 mg/dl) and complication of hypoglycemia, such as seizure, change in consciousness, and cold sweating. Patients in the study cohort maintained their blood glucose within the target range longer (14.1±7.0 vs 9.3±6.1 h/day; p＜0.001) than the controls. The duration of IVII was shorter in the study cohort (5.9±4.3 vs 11.9±7.4 days; p＜0.001) than in the controls. More hypoglycemia was noted in the study cohort, but there were no clinical symptoms of hypoglycemia. Conclusions: Standardization of IVII with titration improves the efficiency of glycemic control in critically ill adults. The traditional sliding-scale IVII used in Taiwan has less glycemic control efficiency in critically ill patient.