Implementation and evaluation of the SPRINT protocol for tight glycaemic control in critically ill patients: a clinical practice change

摘要: Stress-induced hyperglycaemia is prevalent in critical care. Control of blood glucose levels to within a 4.4 6.1 mmol/L range or below 7.75 can reduce mortality and improve clinical outcomes. The Specialised Relative Insulin Nutrition Tables (SPRINT) protocol simple wheel-based system that modulates insulin nutritional inputs for tight glycaemic control. SPRINT was implemented as practice change general intensive care unit (ICU). objective this study measure the effect on control compared with previous ICU methods. Glycaemic outcomes 371 patients median Acute Physiology And Chronic Health Evaluation (APACHE) II score 18 (interquartile [IQR] 15 24) are 413-patient retrospective cohort APACHE (IQR 23). Overall, 53.9% all measurements were band. Blood concentrations found be log-normal thus statistics used throughout describe data. average glycaemia 6.0 (standard deviation 1.5 mmol/L). Only 9.0% mmol/L, 3.8% 4 0.1% 2.2 mmol/L. On SPRINT, 80% more band standard 38% lower peak not correlated (P >0.30). For length stay (LoS) greater than equal 3 days, hospital reduced from 34.1% 25.4% (-26%) = 0.05). LoS 34.3% 23.5% (-32%) 0.02). 5 31.9% 20.6% (-35%) also but P value less 0.13 days. achieved high level severely ill population. Reductions observed hyperglycaemic cohort. Range metrics no longer outcome under SPRINT.