Introduction and evaluation of a computerised insulin protocol
| Autor: | Peter L. Tangkau, Iwan A. Meynaar, Lode Rijks, Eduard F. Salm, L Dawson |
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| Rok vydání: | 2005 |
| Předmět: |
Adult
Blood Glucose Male medicine.medical_specialty Resuscitation Adolescent medicine.medical_treatment Point-of-Care Systems Critical Care and Intensive Care Medicine law.invention law Internal medicine Intensive care Anesthesiology medicine Diabetes Mellitus Humans Insulin Hospital Mortality Pancreatic hormone APACHE Aged Monitoring Physiologic Aged 80 and over business.industry Glucose Measurement Middle Aged Intensive care unit Intensive Care Units Endocrinology Anesthesia Blood sugar regulation Female business Algorithms |
| Zdroj: | Intensive care medicine. 33(4) |
| ISSN: | 0342-4642 |
| Popis: | To lower glucose levels in all patients in the intensive care unit (ICU) to the target range of 4.5-7.5 mmol/l using a nurse-driven computerised insulin protocol in combination with bedside glucose measurement.Cohort study.Mixed adult ICU.All 182 patients admitted to the ICU during a 3-month period were studied, except for 3 patients admitted for diabetic keto-acidosis.Five steps were taken to improve glucose regulation: (1) Nurses were authorised to adjust insulin dosage using a protocol. (2) Glucose was measured more often. (3) Glucose was measured at the bedside. (4) Consecutive protocols aimed for successively lower glucose levels; the final protocol had a target range of 4.5-7.5 mmol/l. (5) The protocol was computerised. MEASUREMENTS AND RESULT: Mean glucose decreased from 9.23 mmol/l without protocol to 7.68 mmol/l with the final protocol. This final protocol with the target of 4.5-7.5 mmol/l was evaluated more extensively. Glucose levels were measured a total of 1854 times in 179 ICU admissions during 552 ICU treatment days. The median glucose level was 7.0 mmol/l, and 53.1% of glucose measurements were within the target range of 4.5-7.5 mmol/l. One episode of hypoglycaemia (glucose/= 2.2 mmol/l) occurred, representing 0.5% of patients or 0.05% of glucose measurements.The combined strategy of successively more ambitious nurse-driven (computerised) insulin protocols and bedside glucose measurement resulted in acceptably low glucose levels with very few episodes of hypoglycaemia. |
| Databáze: | OpenAIRE |
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