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




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Critical Care

, 12:R49

First Online: 16 April 2008Received: 19 December 2007Revised: 06 March 2008Accepted: 16 April 2008

Abstract

IntroductionStress-induced hyperglycaemia is prevalent in critical care. Control of blood glucose levels to within a 4.4 to 6.1 mmol-L range or below 7.75 mmol-L can reduce mortality and improve clinical outcomes. The Specialised Relative Insulin Nutrition Tables SPRINT protocol is a simple wheel-based system that modulates insulin and nutritional inputs for tight glycaemic control.

MethodsSPRINT was implemented as a clinical practice change in a general intensive care unit ICU. The objective of this study was to measure the effect of the SPRINT protocol on glycaemic control and mortality compared with previous ICU control methods. Glycaemic control and mortality outcomes for 371 SPRINT patients with a median Acute Physiology And Chronic Health Evaluation APACHE II score of 18 interquartile range IQR 15 to 24 are compared with a 413-patient retrospective cohort with a median APACHE II score of 18 IQR 15 to 23.

ResultsOverall, 53.9% of all measurements were in the 4.4 to 6.1 mmol-L band. Blood glucose concentrations were found to be log-normal and thus log-normal statistics are used throughout to describe the data. The average log-normal glycaemia was 6.0 mmol-L standard deviation 1.5 mmol-L. Only 9.0% of all measurements were below 4.4 mmol-L, with 3.8% below 4 mmol-L and 0.1% of measurements below 2.2 mmol-L. On SPRINT, 80% more measurements were in the 4.4 to 6.1 mmol-L band and standard deviation of blood glucose was 38% lower compared with the retrospective control. The range and peak of blood glucose were not correlated with mortality for SPRINT patients P >0.30. For ICU length of stay LoS of greater than or equal to 3 days, hospital mortality was reduced from 34.1% to 25.4% -26% P = 0.05. For ICU LoS of greater than or equal to 4 days, hospital mortality was reduced from 34.3% to 23.5% -32% P = 0.02. For ICU LoS of greater than or equal to 5 days, hospital mortality was reduced from 31.9% to 20.6% -35% P = 0.02. ICU mortality was also reduced but the P value was less than 0.13 for ICU LoS of greater than or equal to 4 and 5 days.

ConclusionSPRINT achieved a high level of glycaemic control on a severely ill critical cohort population. Reductions in mortality were observed compared with a retrospective hyperglycaemic cohort. Range and peak blood glucose metrics were no longer correlated with mortality outcome under SPRINT.

AbbreviationsACCPACCP = American College of Chest Physicians

APACHEAPACHE = Acute Physiology And Chronic Health Evaluation

ICUICU = intensive care unit

SPRINTSPRINT = Specialised Relative Insulin Nutrition Tables.

Electronic supplementary materialThe online version of this article doi:10.1186-cc6868 contains supplementary material, which is available to authorized users.

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Author: JGeoffrey Chase - Geoffrey Shaw - Aaron Le Compte - Timothy Lonergan - Michael Willacy - Xing-Wei Wong - Jessica Lin - Thom

Source: https://link.springer.com/



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