Computer-assisted glucose control in critically ill patients.

Autor: Vogelzang M; Department of Critical Care, University Medical Center, University of Groningen, 9700 RB, Groningen, The Netherlands. m.vogelzang@thorax.umcg.nl, Loef BG, Regtien JG, van der Horst IC, van Assen H, Zijlstra F, Nijsten MW
Jazyk: angličtina
Zdroj: Intensive care medicine [Intensive Care Med] 2008 Aug; Vol. 34 (8), pp. 1421-7. Date of Electronic Publication: 2008 Apr 04.
DOI: 10.1007/s00134-008-1091-y
Abstrakt: Objective: Intensive insulin therapy is associated with the risk of hypoglycemia and increased costs of material and personnel. We therefore evaluated the safety and efficiency of a computer-assisted glucose control protocol in a large population of critically ill patients.
Design and Setting: Observational cohort study in three intensive care units (32 beds) in a 1,300-bed university teaching hospital.
Patients: All 2,800 patients admitted to the surgical, neurosurgical, and cardiothoracic units; the study period started at each ICU after implementation of Glucose Regulation for Intensive Care Patients (GRIP), a freely available computer-assisted glucose control protocol.
Measurements and Results: We analysed compliance in relation to recommended insulin pump rates and glucose measurement frequency. Patients were on GRIP-ordered pump rates 97% of time. Median measurement time was 5min late (IQR 20min early to 34 min late). Hypoglycemia was uncommon (7% of patients for mild hypoglycemia, < 3.5mmol/l; 0.86% for severe hypoglycemia, < 2.2 mmol/l). Our predefined target range (4.0-7.5 mmol/l) was reached after a median of 5.6 h (IQR 0.2-11.8) and maintained for 89% (70-100%) of the remaining stay at the ICU. The number of measurements needed was 5.9 (4.8-7.3) per patient per day. In-hospital mortality was 10.1%.
Conclusions: Our computer-assisted glucose control protocol provides safe and efficient glucose regulation in routine intensive care practice. A low rate of hypoglycemic episodes was achieved with a considerably lower number of glucose measurements than used in most other schemes.
Databáze: MEDLINE
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