Practical aspects of implementing tight glucose control in the ICU.
PURPOSE OF REVIEW: The outcomes of intervention studies implementing intensive insulin therapy aimed at tight glucose control (TGC) are yet not conclusive. There is concern about an increasing incidence of hypoglycemic episodes. Normoglycemia is not easy to obtain in a 'real-life' ICU setting. To fa...
| Publicado en: | Current Opinion in Clinical Nutrition & Metabolic Care Vol. 10; no. 2; pp. 178 - 181 |
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| Autores principales: | , |
| Formato: | review Journal Article |
| Publicado: |
Lippincott Williams & Wilkins
2007 Mar
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106128871&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 106128871 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 13631950 MZX jtl: Current Opinion in Clinical Nutrition & Metabolic Care issn: 13631950 maglogo: N pubinfo: dt: 2007 Mar vid: 10 iid: 2 pid: 433 pub: Lippincott Williams & Wilkins place: Baltimore, Maryland artinfo: ui: 106128871 106128871 2009528947 NLM17285006 106128871 ppf: 178 ppct: 3 formats: tig: atl: Practical aspects of implementing tight glucose control in the ICU. aug: au: Vogelzang M Ligtenberg JJM affil: Surgical ICU, Department of Surgery, Intensive & Respiratory Care Unit, University Medical Center Groningen, University of Groningen, the Netherlands. sug: subj: Blood Glucose Analysis Blood Glucose Metabolism Critical Care Standards Hypoglycemic Agents Therapeutic Use Insulin Therapeutic Use Automation Utilization Chemistry, Analytical Utilization Clinical Information Systems Utilization Decision Support Systems, Clinical Utilization Insulin Infusion Systems Utilization Intensive Care Units Standards Protocols Standards ab: PURPOSE OF REVIEW: The outcomes of intervention studies implementing intensive insulin therapy aimed at tight glucose control (TGC) are yet not conclusive. There is concern about an increasing incidence of hypoglycemic episodes. Normoglycemia is not easy to obtain in a 'real-life' ICU setting. To facilitate the implementation of TGC, we review its practical aspects. RECENT FINDINGS: Point-of-care blood gas/glucose analyzers currently present the best trade-off between accuracy and speed. A nurse-driven dynamic scale protocol leads to the most efficacious and safe implementation of TGC. Paper protocols have been published and computerized protocols are a new development. Closed-loop systems are not yet available for clinical use. SUMMARY: Clinicians should take care in selecting both the patient group and target blood glucose level. As long as doubts remain about the potential benefits, it is important to perform TGC in a safe way. This can be done with a nurse-driven protocol, using arterial blood samples measured on a point-of-care blood gas analyzer. Insulin administration should be continuous, and guided by a dynamic scale protocol either on paper or on the computer. Periodical monitoring of performance and incremental modification of the protocol leads to best results. pubtype: Academic Journal doctype: review Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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