Tight glycaemic control by an automated algorithm with time-variant sampling in medical ICU patients

Pachler, Christoph; Plank, Johannes; Weinhandl, Heinz; Chassin, Ludovic J.; Wilinska, Malgorzata E.; Kulnik, Roman; Kaufmann, Peter; Smolle, Karl-Heinz; Pilger, Ernst; Pieber, Thomas R.; Ellmerer, Martin; Hovorka, Roman

doi:10.1007/s00134-008-1033-8

Cited by 77 publications

(45 citation statements)

References 29 publications

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“…First, some possibilities of selection bias may exist in this study because of small number of subjects of study group. Second, EN may also be a useful prophylaxis against stress ulceration 31,34,35) . But, it was not analyzed in our present study.…”

Section: Discussionmentioning

confidence: 99%

Impact of Early Enteral Nutrition on In-Hospital Mortality in Patients with Hypertensive Intracerebral Hemorrhage

Lee

Jwa

et al. 2010

J Korean Neurosurg Soc

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Objective : We conducted this study to evaluate the clinical impact of early enteral nutrition (EN) on in-hospital mortality and outcome in patients with critical hypertensive intracerebral hemorrhage (ICH). Methods : We retrospectively analyzed 123 ICH patients with Glasgow Coma Scale (GCS) score of 3-12. We divided the subjects into two groups : early EN group (< 48 hours, n = 89) and delayed EN group (≥ 48 hours, n = 34). Body weight, total intake and output, serum albumin, Creactive protein, infectious complications, morbidity at discharge and in-hospital mortality were compared with statistical analysis. Results : The incidence of nosocomial pneumonia and length of intensive care unit stay were significantly lower in the early EN group than in the delayed EN group (p < 0.05). In-hospital mortality was less in the early EN group than in the delayed EN group (10.1% vs. 35.3%, respectively; p = 0.001). By multivariate analysis, early EN [odds ratio (OR) 0.229, 95% CI : 0.066-0.793], nosocomial pneumonia (OR = 5.381, 95% CI : 1.621-17.865) and initial GCS score (OR = 1.482 95% CI : 1.160-1.893) were independent predictors of in-hospital mortality in patients with critical hypertensive ICH. Conclusion : These findings indicate that early EN is an important predictor of outcome in patients with critical hypertensive ICH.

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Section: Discussionmentioning

confidence: 99%

Impact of Early Enteral Nutrition on In-Hospital Mortality in Patients with Hypertensive Intracerebral Hemorrhage

Lee

Jwa

et al. 2010

J Korean Neurosurg Soc

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“…This allowed direct comparison, similar to that offered by crossover clinical trials, among glucose measurement methods (continuous vs intermittent) and glycemic control protocols. The simulated experiments used a virtual population of critically ill patients, developed from data collected in multicenter multinational clinical trials (22)(23)(24)(25)(26) and validated against independent clinical data (21 ).…”

Section: Methodsmentioning

confidence: 99%

“…The virtual patients were created from clinical database collected in 56 critically ill patients, 29 patients treated in the medical ICU [25 men age 66.7 (11.7) years; weight 76.5 (14.6) kg, 5 with diabetes; acute physiology and chronic health evaluation II (APACHE II) score 19 (16 -24); total carbohydrate intake 7.2 (3.8) g/h] and 27 in the surgical ICU [16 men age 62.6 (13.7) years; weight 83.5 (18.4) kg, 7 with diabetes; APACHE II 22 (19 -25); total carbohydrate intake 7.5 (3.5) g/h] at Charles University, Prague, Czech Republic (22,23 ); Medical University, Graz, Austria (23,24 ); Katholieke Universiteit, Leuven, Belgium (25,26 ); and Royal Brompton Hospital, London (23,25 ).…”

Section: Virtual Patientsmentioning

confidence: 99%

Glucose Control in the Intensive Care Unit by Use of Continuous Glucose Monitoring: What Level of Measurement Error Is Acceptable?

Wilinska

Hovorka

2014

Clinical Chemistry

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BACKGROUND Accuracy and frequency of glucose measurement is essential to achieve safe and efficacious glucose control in the intensive care unit. Emerging continuous glucose monitors provide frequent measurements, trending information, and alarms. The objective of this study was to establish the level of accuracy of continuous glucose monitoring (CGM) associated with safe and efficacious glucose control in the intensive care unit. METHODS We evaluated 3 established glucose control protocols [Yale, University of Washington, and Normoglycemia in Intensive Care Evaluation and Surviving Using Glucose Algorithm Regulation (NICE-SUGAR)] by use of computer simulations. Insulin delivery was informed by intermittent blood glucose (BG) measurements or CGM levels with an increasing level of measurement error. Measures of glucose control included mean glucose, glucose variability, proportion of time glucose was in target range, and hypoglycemia episodes. RESULTS Apart from the Washington protocol, CGM with mean absolute relative deviation (MARD) ≤15% resulted in similar mean glucose as with the use of intermittent BG measurements. Glucose variability was also similar between CGM and BG-informed protocols. Frequency and duration of hypoglycemia were not worse by use of CGM with MARD ≤10%. Measures of glucose control varied more between protocols than at different levels of the CGM error. CONCLUSIONS The efficacy of CGM-informed and BG-informed commonly used glucose protocols is similar, but the risk of hypoglycemia may be reduced by use of CGM with MARD ≤10%. Protocol choice has greater influence on glucose control measures than the glucose measurement method.

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“…Two studies report of the advantages of a computerized algorithm to facilitate and to increase success rate of tight glucose control. Pachler et al [30] evaluated their algorithm in a small randomized study. They found a mean blood glucose value within the target range and a lower hyperglycemic index in the group using a computerized algorithm, but also a shorter sampling interval.…”

Section: Metabolism and Nutritionmentioning

confidence: 99%

Year in review in Intensive Care Medicine, 2008: I. Brain injury and neurology, renal failure and endocrinology, metabolism and nutrition, sepsis, infections and pneumonia

et al. 2008

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Tight glycaemic control by an automated algorithm with time-variant sampling in medical ICU patients

Abstract: The eMPC algorithm was effective in maintaining tight glycaemic control in severely ill medical ICU patients.

Cited by 77 publications

References 29 publications

Impact of Early Enteral Nutrition on In-Hospital Mortality in Patients with Hypertensive Intracerebral Hemorrhage

Impact of Early Enteral Nutrition on In-Hospital Mortality in Patients with Hypertensive Intracerebral Hemorrhage

Glucose Control in the Intensive Care Unit by Use of Continuous Glucose Monitoring: What Level of Measurement Error Is Acceptable?

Year in review in Intensive Care Medicine, 2008: I. Brain injury and neurology, renal failure and endocrinology, metabolism and nutrition, sepsis, infections and pneumonia

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