BACKGROUND:Control of hyperglycemia in adult medical and surgical intensive care units (ICUs) has been shown to dramatically decrease morbidity and mortality. Algorithms to achieve glycemic control in the ICU setting are evolving. We have evaluated the use of a discrete proportional-integral-derivative (PID) algorithm to control hyperglycemia in pediatric ICU (PICU) patients both with and without diabetes. METHODS:Six PICU patients [four with diabetic ketoacidosis (DKA) and two with glucocorticoid-induced hyperglycemia] with glucose values >150 mg/dL were enrolled. Their hyperglycemia was managed with a PID algorithm that provided recommendations for both changes in the intravenous insulin infusion rate and the time to obtain the next discrete glucose value. Glucose targets were adjusted based on clinical circumstances. RESULTS:Patients (mean age 9.2 years; range 1.8-14 years) utilized the algorithm for a total of 454.4 h. Mean time to the initial glucose target was 8.7 h (range 1.3-15.1 h) in five patients. One subject with hyperosmolar DKA did not achieve target before discharge from the PICU, and another was at target when the algorithm was initiated. After the glucose target was achieved, the mean SD was 23.5 mg/dL, and glucose values were >40 mg/dL above target 13% of the time and <40 mg/dL below target 1% of the time. There were no glucose values <55 mg/dL. CONCLUSION:The PID algorithm safely and effectively controlled hyperglycemia in a PICU, despite multiple changes in intravenous fluids, steroid doses (including high-dose pulses), and hemodialysis.

译文

摘要背景:控制成人医学和外科重症监护病房(ICU)的高血糖症已显着降低发病率和死亡率。在ICU设置中实现血糖控制的算法正在不断发展。我们评估了使用离散比例积分微分(PID)算法来控制有或没有糖尿病的小儿ICU(PICU)患者的高血糖。
方法:招募了6例PICU患者[其中4例患有糖尿病酮症酸中毒(DKA),2例患有糖皮质激素引起的高血糖症],其血糖值> 150 mg / dL。他们的高血糖症通过PID算法进行管理,该算法为静脉内胰岛素输注速率的变化以及获得下一个离散葡萄糖值的时间提供了建议。根据临床情况调整葡萄糖靶标。
结果:患者(平均年龄9.2岁;范围1.8-14岁)使用该算法的时间总计为454.4小时。五名患者达到初始血糖目标的平均时间为8.7小时(范围1.3-15.1小时)。高渗性DKA的一名受试者在未从PICU出院前未达到目标,另一名受试者在算法启动时就达到了目标。达到葡萄糖目标后,平均SD为23.5 mg / dL,并且葡萄糖值在目标时间的13%之上大于40 mg / dL,在目标时间的1%以下小于40 mg / dL。没有葡萄糖值<55mg / dL。
结论:尽管静脉输液,类固醇剂量(包括大剂量脉搏)和血液透析发生了多种变化,PID算法仍可安全有效地控制PICU中的高血糖。

+1
+2
100研值 100研值 ¥99课程
检索文献一次
下载文献一次

去下载>

成功解锁2个技能,为你点赞

《SCI写作十大必备语法》
解决你的SCI语法难题!

技能熟练度+1

视频课《玩转文献检索》
让你成为检索达人!

恭喜完成新手挑战

手机微信扫一扫,添加好友领取

免费领《Endnote文献管理工具+教程》

微信扫码, 免费领取

手机登录

获取验证码
登录