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Báo cáo y học: "Tight glycaemic control: intelligent technology or a nurse-wise strategy"

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  1. Available online http://ccforum.com/content/11/5/421 Letter Tight glycaemic control: intelligent technology or a nurse-wise strategy? Mart J de Graaff1,2, Peter E Spronk1,3,4 and Marcus J Schultz1,2,3 1Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands 2Laboratoryof Experimental Intensive Care and Anesthesiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands 3Hermes Critical Care Group, Gelre Hospitals (location Lucas), Apeldoorn, The Netherlands 4Department of Intensive Care Medicine, Gelre Hospitals (location Lucas), Albert Schweitzerlaan 31, 7334 DZ Apeldoorn, The Netherlands Corresponding author: Mart J de Graaff, m.j.degraaff@amc.uva.nl Published: 24 September 2007 Critical Care 2007, 11:421 (doi:10.1186/cc6124) This article is online at http://ccforum.com/content/11/5/421 © 2007 BioMed Central Ltd See related research by Shulman et al., http://ccforum.com/content/11/4/R75 Despite disappointing findings with the computerized Competing interests decision-supported tight glycaemic control (TGC) protocol, The authors declare that they have no competing interests. Shulman and colleagues [1] argue that one reason to References proceed with computerized TGC protocols is that complex 1 Shulman R, Finney SJ, O’Sullivan C, Glynne PA, Greene R: Tight protocols remain mandatory for TGC. Indeed, most glycaemic control: a prospective observational study of a intensivists think of TGC as difficult and complex. In The computerised decision-supported intensive insulin therapy protocol. Crit Care 2007, 11:R75. Netherlands as many as 46 different protocols are in use, 2 Van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyn- including protocols with flowcharts, sliding scales, calculators inckx F, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P, Bouil- and conversion tables as well as computerized decision- lon R: Intensive insulin therapy in the critically ill patients. N Engl J Med 2001, 345:1359-1367. support protocols (survey, de Graaff MJ, Royakkers AANM, 3 Van den Berghe G, Wilmer A, Hermans G, Meersseman W, Kieft H, Spronk PE, van der Sluijs HP, Schultz MJ, Wouters PJ, Milants I, Van Wijngaerden E, Bobbaers H, Bouillon R: Intensive insulin therapy in the medical ICU. N Engl J Med unpublished data); they all are exceptionally complex and 2006, 354:449-461. frequently difficult to follow. We recently had the opportunity to visit the Leuven hospital and were surprised to see their protocol, which is remarkably concise, far from complex, and consequently very easy to follow. In fact, their protocol is no more than a small set of written guidelines that nurses hardly ever use after having gained experience with it for some months, because (to quote the nurses) ‘TGC is something you do by heart, not from a sheet of paper’. In addition, the large number of blood glucose level (BGL) measurements (almost one BGL measurement every 75 minutes) with the tested computerized TGC protocol [1] is not comparable with the original studies of TGC [2,3] or with current practice in Leuven. Rather, such frequent measurements may explain the high incidence of protocol violations: it was common for BGL measurements to be performed too infrequently or too late. There is a need to standardize TGC. But let’s start the easy way first: a simple protocol that forms a solid and practical basis for nurses. BGL = blood glucose level; TGC = tight glycaemic control. Page 1 of 1 (page number not for citation purposes)
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