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PubMed1991

An improved lidocaine infusion protocol for cardiac surgical patients.

A new protocol for lidocaine administration was tested to determine whether it would provide higher free and total serum lidocaine concentrations during and after weaning from cardiopulmonary bypass (CPB), without leading to accumulation toxicity, than those resulting from a conventional protocol (1.5 mg/kg loading dose bolus + 2 mg/min infusion rate). Ten elective adult cardiac surgical patients were studied. Ten seconds prior to aortic cross-clamp release (0 min), each patient received a lidocaine bolus (1.5 mg/kg) and simultaneous lidocaine infusion (5 mg/min for 1 hour, followed by 2 mg/min for 23 hours). Weaning occurred 20 to 30 minutes after cross-clamp release. Lidocaine levels were determined from arterial blood samples at 0, 10, 20, 30, and 60 minutes, and at 2, 4, and 24 hours postcross-clamp release. Compared with the conventional protocol, the new protocol showed a significant increase in mean total lidocaine concentration (P less than or equal to 0.02) at 30 and 60 minutes, and a significant increase in mean free lidocaine concentration (P less than or equal to 0.005) at 20, 30, and 60 minutes. No patient had toxic levels at 24 hours. Results of this study suggest that in patients undergoing cardiac surgery, a "5 + 2" mg/min infusion protocol is safe and superior to a conventional protocol in achieving therapeutic serum levels of free and total lidocaine.

Adult↗

PubMed2004

An extended 10-core transrectal ultrasonography guided prostate biopsy protocol improves the detection of prostate cancer.

OBJECTIVE: To evaluate the efficacy of TRUS guided 10-core biopsy strategy for Turkish patients who had biopsy of the prostate for the first time. METHODS: Between February 2001 and May 2003, 303 consecutive men with suspected prostate cancer were included in the study. Indications for TRUS guided prostate biopsy were: abnormal digital rectal examination and/or a serum PSA over 2.5 ng/ml. All of the patients underwent a 10-core biopsy protocol with additional core from the each suspicious area detected by TRUS. Besides the sextant technique, 4 more biopsies were obtained from the lateral peripheral zone. We aimed to analyze whether cancer detection improved with the extended versus the standard sextant biopsy in our series overall and in each subgroup. RESULTS: Of 303 patients 94 (31%) were positive for prostate cancer. Median age and PSA of prostate cancer patients were significantly higher than of the non-cancer patients. Besides prostate volumes of the cancer patients were significantly lower than of the non-cancer ones. The cancer detection rates were 31% (94/303) and 23.1% (70/303) for the 10-core biopsy strategy and sextant biopsy strategies, respectively. Thus the 10-core biopsy technique increased cancer detection rate by 25.5% (24/94) for the whole group of patients. A statistically significant number of additional cancers were detected with 10-core biopsy strategy for all the subgroups of the patients. Furthermore 10-core biopsy protocol detected more cancers (at least 6.4%) than all the probable different combinations of 8-core biopsy protocols. Among the 94 cancer patients, biopsy from a suspicious area revealed cancer in 31.9% of them; however, in all of these patients cancer was already present in the 10-core biopsy. On the other hand, lesion biopsies revealed 5.7% additional cancers if sextant technique was used. There were only 3 (0.9%) serious complications requiring hospitalization and all 3 were infections controlled by appropriate antibiotics. CONCLUSION: Adding 4 lateral peripheral biopsies to the conventional sextant biopsy (10-core biopsy strategy) technique has increased the cancer detection rate by 25.5% without significant morbidity and without increasing the number of insignificant cancers. 10-core biopsy protocol was superior to all probable 8-core biopsy protocols in our study group. Additional biopsies from suspicious areas detected by transrectal ultrasonography revealed no further benefit if 10-core technique was used. We therefore suggest that 10-core biopsy protocol should be the preferred strategy in early detection of prostate cancer.

Adult↗

PubMed2005

Influence of the exercise protocol on peak VO2 in patients after heart transplantation.

BACKGROUND: The protocol and the duration of an exercise test have considerable influence on peak oxygen consumption (VO2). On a bicycle ergometer, the use of a ramp protocol with a target exercise duration of 8 to 12 minutes is recommended to reliably measure maximal oxygen uptake. Because of cardiac denervation, heart transplant recipients have a delayed heart rate adaptation to exercise, and oxygen uptake kinetics are altered. METHODS: We investigated whether the rate of workload increase during exercise testing would influence peak VO2 after heart transplantation. Two symptom-limited exercise tests, applying a ramp and a 3-minute step protocol were effectuated on a bicycle ergometer. RESULTS: Seventeen patients (14 men, 3 women), mean age 58.4 +/- 12.7 years, at 64.5 +/- 26.7 months post-transplant participated in the study. No statistically significant differences between the 2 protocols were found regarding total exercise duration until exhaustion (8:42 +/- 2:09 vs 8:48 +/- 2:27 minutes, p = 0.705), maximal workload reached (117.9 +/- 42.6 vs 106.4 +/- 40.5 W; p = 0.055), peak heart rate (135.8 +/- 11.6 vs 131.2 +/- 14.8 beats/min.; p = 0.061), and peak VO2 (20.9 +/- 5.2 vs 20.5 +/- 5.9 ml/kg/min; p = 0.538). CONCLUSIONS: Peak VO2 seems insensitive to a stepwise or ramping exercise protocol in heart transplant patients when the workload increments are chosen in a way that a total exercise time of 8 to 12 minutes is achieved. Both protocols can therefore be applied to evaluate peak VO2.

Adaptation, Physiological↗

PubMed2004

Respiratory care protocol development and impact.

Respiratory care (RC) protocols are widely regarded as the most appropriate method for properly allocating and delivering most forms of respiratory therapy. The use of protocols has increased steadily over the past 15 years, but, despite the successes and modest implementation of RC protocols across the country, there is room for improvement in adopting RC protocols for the effective use of respiratory care services. It also seems that many physicians have yet to be won over, and RC managers need to take the first step toward protocol development and implementation. This article addresses some of the issues surrounding the development of respiratory care protocols and the impact that their implementation may have based on experience gained to date.

Clinical Protocols↗

PubMed2000

Audit of the effect of a fast tracking protocol on transfer time from A&E to ward for patients with hip fractures.

The objective of this project was to study the effect of a "fast tracking protocol" on the time spent in the A&E department by patients with hip fractures. A review of 104 patients with hip fractures admitted via the A&E department between March 1997 and September 1997 (7 months) in a District General Hospital (Alexandra Hospital, Redditch) showed that many patients spent more than 2 h lying on uncomfortable trolleys in the department. A fast tracking protocol was devised for a quicker as well as safe transfer of these patients to the ward. This was implemented from December 1997 and its effects closely monitored on a monthly basis for the next 7 months up to June 1998. Results showed that the fast tracking protocol produced a significant reduction in the time spent in the A&E department by 90 out of the 100 patients with hip fractures. The transfer time (mean+/-SD) before the fast tracking process was 2 h 45 min +/- 57 min (N=104, median=2 h 40 min). After the protocol was implemented this was reduced to 1 h 32 min +/- 40.87 min (N= 90, median= 1 h 25 min). This reduction is statistically significant (p < 0. 001; Student t test). Also, more patients were transferred within the target time of 1 h (24 out of 90 patients) compared with before the introduction of the protocol (3 out of 104 patients). This was also statistically significant (p < 0.001; Chi-square test). Ten out of 100 patients were not fast tracked because of multiple injuries, acute medical problems or inconclusive diagnosis. These patients still spent an average of 2 h 55 min (median 2 h 55 min) in the A&E department. In conclusion, the fast tracking protocol significantly reduces time spent in the A&E department by patients with isolated hip fractures. There is also a significant increase in the number of patients transferred within the hour. This has numerous benefits for the patients as well as the A&E department.

Aged↗

PubMed2000

Judging the use of clinical protocols by fellow professionals.

The objective of this study was to investigate the judgements of British doctors, nurses and midwives about behaviour which complies with a protocol, violates a protocol, or constitutes an improvisation where no protocol exists. Primary data were collected on the judgments of hospital healthcare professionals (N = 310) from three specialties in each of three hospitals. Respondents were required to judge the appropriateness of the behaviour of a fellow professional in each of nine hypothetical scenarios generated on the basis of previous focus group discussions. They were also asked how likely they would be to report this professional to a senior member of staff. Within the scenarios, both behaviour with respect to the relevant clinical protocol and outcome for the patient were experimentally manipulated. Data were collected using a survey questionnaire. The three professional groups studied (doctors, nurses and midwives) were found to make significantly different judgements. Crucially, doctors judged the violation of a protocol as less inappropriate than did nurses or midwives. Midwives were disapproving of violations, even when the patient outcome was good. These differences were reflected in the ratings of reporting likelihood. The proliferation of clinical protocols likely to occur in Britain in the coming years will need to be managed with great care if the regulation of clinical behaviour is the goal. Particular care will be needed to avoid the exacerbation of professional tensions.

Anesthesiology↗

PubMed2003

Automated monitoring of medical protocols: a secure and distributed architecture.

The control of the right application of medical protocols is a key issue in hospital environments. For the automated monitoring of medical protocols, we need a domain-independent language for their representation and a fully, or semi, autonomous system that understands the protocols and supervises their application. In this paper we describe a specification language and a multi-agent system architecture for monitoring medical protocols. We model medical services in hospital environments as specialized domain agents and interpret a medical protocol as a negotiation process between agents. A medical service can be involved in multiple medical protocols, and so specialized domain agents are independent of negotiation processes and autonomous system agents perform monitoring tasks. We present the detailed architecture of the system agents and of an important domain agent, the database broker agent, that is responsible of obtaining relevant information about the clinical history of patients. We also describe how we tackle the problems of privacy, integrity and authentication during the process of exchanging information between agents.

Artificial Intelligence↗

PubMed1995

An audit of the use of agreed treatment protocols at a major centre for cancer treatment.

The treatment that a patient with cancer receives may vary considerably, depending on where and by whom the treatment is given. Agreement on treatment protocols for patients undergoing cancer treatment is clearly a desirable aim. Within departments this will result in greater uniformity of treatment, lead to greater safety, facilitate the evaluation of treatment strategies, and improve cost effectiveness. We have examined prospectively the extent to which treatment protocols are being adhered to within a major cancer treatment centre. One hundred newly registered cancer patients were studied. The results are encouraging, with complete adherence to protocol for 84. Of the 16 occurrences of deviation from a protocol this was unavoidable for three and of minor importance for five, being relatively small changes in radiotherapy dose reflecting particular clinical situations. Thus, eight deviations represented serious departures from the protocols by the responsible clinicians. This study has shown that in a major cancer treatment centre the development of agreed treatment protocols is both feasible and practical.

Adult↗

PubMedDate not supplied

[Assessment of the efficacy of the implementation of an arterial cannulation protocol as quality assurance method].

AIM: Arterial cannulation is a usual technique in intensive care. With this study, we aim to assess the efficacy of the implementation of an arterial cannulation protocol. MATERIAL AND METHOD: The study was performed in several phases: a first cross-sectional cut-off to assess the technique performed and the incidence of complications, without knowledge of the study by the staff involved. There was a second phase of development and explanation to the unit staff of a protocol performed based on the results obtained and the available evidence. The third phase was of reevaluation of the results after the implementation of the protocol by a new cross-sectional cut-off without knowledge of the staff. RESULTS: In phase 1, a total of 100 arterial cannulations were studied, obtaining the existence of a large amount of catheters not fixed by suture (44%) and a significant percentage of cases of accidental withdrawal (15%) as fundamental results. The protocol was implemented to solve these problems. It stressed the suture of all the cannalized catheters. Data on 80 patients and 133 catheters have now been gathered. The percentage of catheters that were sutured according to the protocol indication was 98%, significantly greater than phase 1 (p< 0.0001). The number of catheters whose withdrawal reason was accident removal was also significantly inferior (4%; p = 0.002). CONCLUSIONS: The implementation of an arterial cannulation protocol with a high rate of follow-up by the nursing staff has achieved a reduction in the incidence of iatrogenies due to the technique.

Catheterization, Peripheral↗

PubMedDate not supplied

Building a flexible protocol information system with ready for use' web-technology.

This paper describes how web technology, currently available, can be used to build a fast and easy flexible protocol information system. The interface design and functionalities of the system were based on experiences with a previous version of a protocol information system (ProtoVIEW). A wide range of diagnostic or therapeutic protocols could be retrieved and viewed with ProtoVIEW. The Web-based version contains all functionalities of the non web-based version plus several new functionalities. The web version contains an X-ray viewer and a great deal of interactivity such as validation of electronic patient data forms. The most important additional function is the context sensitive protocol support that may lead to improved protocol adherence. Finally, the web-based version can be accessed from any working place since patient data and protocols are stored centrally.

Cholestasis↗

PubMed2003

Histological evaluation of renal allograft protocol biopsies in the early period and 1 year after transplantation.

We histologically evaluated protocol biopsy specimens of renal allografts obtained in the early period and 1 year after transplantation. The patients were divided into those with at least one history of acute rejection (AR group) and no history of rejection (NAR group), and the histopathological features in the two groups were compared. A total of 45 early protocol biopsy specimens were obtained from 40 patients, and 31 1-year biopsy specimens were obtained from 30 patients. Acute rejection (AR) or borderline change was observed in the early protocol biopsy specimens from 19 (45.2%) cases. AR or borderline change was observed in 12 of 19 (63.2%) in the AR group, and in 7/26 cases (26.9%) in the NAR group. The incidence of AR or borderline change in the AR group was higher than in the NAR group. Toxic tubulopathy was found in the early protocol biopsy in 16 cases (35.6%). The 1-year biopsies tended to reveal more complicated findings. Chronic rejection (CR) was seen in 8/16 cases (50.0%) in the AR group, and it was more frequent than NAR group (two cases, 13.3%). In conclusion, the incidences of both AR and CR were higher in the cases with a previous episode of AR. The early protocol biopsy was useful in screening for subclinical AR and toxic tubulopathy. The 1-year biopsy was useful for evaluating various types of chronic graft damage. We expect that adequate treatment based on protocol biopsy findings in each patient will lead to better graft survival.

Adolescent↗

PubMed2002

Anaplastic thyroid carcinoma: three protocols combining doxorubicin, hyperfractionated radiotherapy and surgery.

Patients with anaplastic thyroid carcinoma can rarely be cured, but every effort should be made to prevent death due to suffocation. Between 1984 and 1999, 55 consecutive patients with anaplastic thyroid carcinoma were prospectively treated according to a combined regimen consisting of hyperfractionated radiotherapy, doxorubicin, and when feasible surgery. Radiotherapy was carried out for 5 days a week. The daily fraction until 1988 was 1.0 Gyx2 (A) and 1989-92 1.3 Gyx2 (B). Thereafter 1.6 Gyx2 (C) was administered. Radiotherapy was administered to a total target dose of 46 Gy; of which 30 Gy was administered preoperatively in the first two protocols (A and B), while the whole dose was given preoperatively in the third protocol (C). The therapy was otherwise identical. Twenty mg doxorubicin was administered intravenously weekly. Surgery was possible in 40 patients. No patient failed to complete the protocol due to toxicity. In only 13 cases (24%) was death attributed to local failure. Five patients (9%) 'had a survival' exceeding 2 years. No signs of local recurrence were seen in 33 patients (60%); 5 out of 16 patients in Protocol A, 11 out of 17 patients in Protocol B, 17 out of 22 patients in Protocol C (P=0.017). In the 40 patients undergoing additional surgery, no signs of local recurrence were seen in 5 out of 9 patients, 11 out of 14 patients and 17 out of 17 patients, respectively (P=0.005).

Aged↗

PubMed2001

Differences in efficacy between intention-to-treat and per-protocol analyses for patients with psoriasis vulgaris and atopic dermatitis: clinical and pharmacoeconomic implications.

BACKGROUND: Pharmacoeconomic outcome research is based on three criteria: (i) evaluation of objective therapeutic effects; (ii) quality of life; and (iii) treatment costs. Evaluation of therapeutic effect is mainly based on the results of clinical trials using objective clinical measures, e.g: Psoriasis Area and Severity Index (PASI) (score for psoriasis vulgaris) and the Severity Scoring of Atopic Dermatitis (SCORAD) (score for atopic dermatitis). In most studies, only results for a treatment-optimized subpopulation (patients treated according to the protocol) are presented in publications. The relevance of such data for daily routine therapy is doubtful. OBJECTIVES: Our purpose was to investigate the expected loss of effectiveness of switching from a clinical trial to daily routine therapy for the synchronous application of narrow-band ultraviolet (UV) B phototherapy (311 nm) and bathing in 10% Dead Sea salt solution (synchronous balneophototherapy) for patients with psoriasis vulgaris and atopic dermatitis. METHODS: We conducted a multicentre, uncontrolled observational study of outpatients. To achieve data for 'clinical trial' and 'daily routine' situations, two populations were compared: (i) all patients strictly treated according to the protocol (ATP) with no protocol deviations (data published in clinical trials), and (ii) all patients participating in the study who received active treatment at least once, despite treatment irregularities, non-compliance, early withdrawal or other protocol violations [intention-to-treat-population (ITT), model for 'daily routine']. RESULTS: A total of 2526 patients were included in the ITT analysis for psoriasis vulgaris (n = 487 for atopic dermatitis), of which 818 patients could be analysed according to protocol (n = 104 for atopic dermatitis). Striking differences in the therapeutic effect between both groups (ITT and ATP) were found using relative PASI and SCORAD score improvement: 11% (57% 'daily routine' vs. 68% in 'clinical trial') for psoriasis vulgaris and 16% (39% 'daily routine' vs. 55% 'clinical trial') for atopic dermatitis. The main reasons for excluding patients from the 'clinical trial' group were early study withdrawal in 29% (atopic dermatitis, 47%) of patients and fewer treatments per week than planned in the protocol in 24% (atopic dermatitis, 52%). CONCLUSIONS: Our data clearly indicate that for the prediction of the therapeutic effect for daily routine therapy the ITT data appear to be more relevant than the ATP results (i.e. those presented in clinical trials). Although these data are only a first step for evaluating the 'real' therapeutic effect of a treatment modality in daily routine, they seem to support the requirements for ITT analyses in efficacy studies and demonstrate the necessity of ITT data for pharmacoeconomic evaluation.

Adult↗

PubMed2003

The usefulness of a modified adult protocol for the clearance of paediatric cervical spine injury in the emergency department.

OBJECTIVE: To determine if the use of a modified adult protocol that uses cervical spine imaging on presentation for the assessment of cervical spine injury in children improves clinical outcome. METHODS: This is a case series study on all consecutive trauma patients presenting from April to July 2000 inclusive to the ED of a major paediatric trauma hospital. Children presenting to the ED with potential cervical spine injury (CSI) were identified using standard selection criteria. Patient demographics, mechanism of injury, method and time of presentation, associated injuries, radiological investigation and clinical outcome were recorded. The major outcome measures for this study were: time to clearance of the cervical spine, length of stay in the ED and admission to an in-hospital bed. Data were analysed for compliance to the protocol, this being the standard assessment pathway of cervical spine clearance used by our trauma service. RESULTS: The trauma registry identified 1721 trauma presentations during the 4-month study period; 208 presentations representing 200 children with potential CSI were entered into the study. Males represented 72.5% of the study population, having a mean age of 8.32 years, although 29% were less than 5 years of age. The majority of presentations (69%) occurred outside of normal working hours. In 17.8% of cases the cervical spine was cleared based on clinical assessment alone, half less than 5 years of age. Compliance to the protocol occurred in 78% of presentations. However, when examined by age group, children 5 years of age or above were 1.5 times more likely to comply with the protocol as compared with younger children. Adequate plain imaging was not obtained in 18% of presentations, this group almost exclusively less than 5 years of age. There were no missed injuries and no short or long-term neurological sequelae reported during this study. There were no differences in time to clearance, length of stay and admission rate between compliant and non-compliant groups. CONCLUSIONS: Modified adult protocols for cervical spine clearance offer guidance in managing the majority of children suffering blunt trauma. However, we recommend caution in rigidly applying such protocols, especially to children of young age.

Adult↗

PubMed2001

Can an out-of-hospital cervical spine clearance protocol identify all patients with injuries? An argument for selective immobilization.

STUDY OBJECTIVE: We sought to determine the sensitivity of the Fresno/Kings/Madera emergency medical services (EMS) selective spine immobilization protocol in identifying patients with potential cervical injuries. We also sought to determine whether the protocol was safe in the out-of-hospital setting. METHODS: We conducted a retrospective chart review of all patients discharged from 5 trauma-receiving hospitals in Fresno County with the diagnosis of cervical spine injury between July 1, 1990, and June 30, 1996. All of these patients transported to the hospital by EMS personnel were selected for the study group. Medical records of those patients not immobilized were further investigated to identify protocol violations or deficiencies. RESULTS: There were 861 patients with significant cervical injuries during this time span. EMS personnel brought 504 patients to the hospital, of which 495 arrived in cervical spine immobilization. Of the remaining 9 patients, 2 refused immobilization, and 2 could not be immobilized; 3 injuries were missed by the protocol criteria, and 2 injuries were missed because of protocol violations. Of these last 5 patients, 1 patient had an adverse outcome, 2 injuries were considered unstable, 4 patients were older than 67 years, and one patient was 9 months old. CONCLUSION: The Fresno/Kings/Madera EMS selective spine immobilization protocol is 99% (95% CI, 97.7% to 99.7%) sensitive in identifying patients with cervical injuries for immobilization. Those patients not identified were at extremes of age. These results suggest that selective immobilization may be safely applied in the out-of-hospital setting but should be used with caution at extremes of age.

Adolescent↗

PubMedDate not supplied

Prehospital administration of morphine for isolated extremity injuries: a change in protocol reduces time to medication.

OBJECTIVE: To evaluate the effect of a new protocol allowing paramedics to administer morphine without a physician order to patients with extremity trauma with respect to time of morphine administration, scene time, morphine amount and number of doses per patient, and proportion of patients receiving morphine. METHODS: Data were abstracted from transport forms for a ten-month period prior to the implementation of the new protocol and for nine months after implementation. Data elements included patient age and sex, date, time of EMS arrival on scene, amount and number of morphine doses, and total number of patients transported. RESULTS: Implementation of the new protocol was associated with a decrease in time between emergency medical services (EMS) arrival on scene and administration of the first dose of morphine from 18.8 to 16.7 minutes, a difference of 2.1 minutes [95% confidence interval (95%CI) 1.3, 2.9]. The proportion of patients receiving analgesia at the scene, rather than during transport, increased from 62.7% before the protocol change to 69.5% after, an increase of 6.8% (95% CI 2.7, 11.0). Transports before and after implementation of the new protocol did not differ with respect to patient sex, age, or chief complaint; number of morphine doses or total morphine administered per patient; or proportion of prehospital patients receiving morphine. CONCLUSIONS: A change in protocol that permits trained paramedics to administer morphine without physician approval reduces time to analgesia administration without influencing the amount of morphine delivered per patient or the rate of prehospital morphine use. Further study should measure the effect on base hospital physician interruptions and patient outcome.

Adolescent↗

PubMedDate not supplied

Children with special health care needs: a template for prehospital protocol development.

There are 12 million children in the United States with special health care needs. Improvements in medical technology, managed care, and changing social views about the institutionalization of children have all contributed to an increasing number of children with special health care needs (CSHCN) residing primarily in their home communities. Because of the dynamic and fragile nature of the medical conditions typically borne by CSHCN, the need for emergency care is not uncommon and prehospital providers are increasingly likely to encounter this population. Few states have initiated emergency medical services (EMS) protocols addressing field assessment, management, and stabilization of CSHCN and existing model protocols have not yet incorporated a distinct CSHCN component. With the support of grant funding from the federal Emergency Medical Services for Children (EMSC) program, a project was undertaken by investigators in the Center for Prehospital Pediatrics at Children's National Medical Center to develop prehospital protocols for CSHCN. This report details the protocol development process, discusses suggestions for their use, and presents the detailed protocols. The protocols are intended to serve as a resource template for the development and/or revision of jurisdiction-specific, customized practice guidelines.

Child↗

PubMed2006

A pilot study of the SPRINT protocol for tight glycemic control in critically Ill patients.

BACKGROUND: Stress-induced hyperglycemia is prevalent in critical care, even in patients with no history of diabetes. Increased counter-regulatory hormone response increases gluconeogenesis and effective insulin resistance, which can be exacerbated by drug therapy. Control of blood glucose levels to the 4.0-6.1 mmol/L range has been shown to reduce mortality and improve clinical outcomes. The Specialized Relative Insulin and Nutrition Tables (SPRINT) protocol is a simple alternative intensive care unit protocol for modulating insulin and nutritional input to gain tight blood glucose control in the 4.0-6.1 mmol/L target band. The look-up tables, implemented in a wheel-based format, are used by nurses to determine glycemic control actions based on hourly or 2-hourly blood glucose measurements and nutrition and insulin administration rates. METHODS: An 11 patient pilot study was conducted comprising 2,152 hours of blood glucose level control using the SPRINT protocol. The patient cohort average Acute Physiology and Chronic Health Evaluation II score was 22, which was higher than previous intensive insulin clinical studies. RESULTS: Overall, 64% of measurements were in the 4.0-6.1 mmol/L band, 89% in the 4.0-7.0 mmol/L band, and 96% of all measurements in the 4.0-7.75 mmol/L band. The average value was 5.8 +/- 0.9 mmol/L. Only 1.4% of all measurements were below 4 mmol/L, with a minimum of 3.2 mmol/L. The maximum value recorded was 11.8 mmol/L. CONCLUSIONS: Control of blood glucose level was achieved using a protocol implemented by the nursing staff without the need for physician intervention or interpretation, where control is defined as maximizing time within a desired band. The results led to a high level of support for the SPRINT protocol among clinical staff and acceptance of the frequent measurement requirement for effective control. The ease-of-use of the protocol resulted in minimal noncompliance by clinical staff.

APACHE↗