Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
SHR Neuro Krebs Kardio Lipid Stoffw Microb
Pachler, C; Plank, J; Weinhandl, H; Chassin, LJ; Wilinska, ME; Kulnik, R; Kaufmann, P; Smolle, KH; Pilger, E; Pieber, TR; Ellmerer, M; Hovorka, R.
Tight glycaemic control by an automated algorithm with time-variant sampling in medical ICU patients.
Intensive Care Med. 2008; 34(7): 1224-1230.
Doi: 10.1007/s00134-008-1033-8
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- Führende Autor*innen der Med Uni Graz
- Pachler Christoph
- Co-Autor*innen der Med Uni Graz
- Ellmerer Martin
- Kulnik Roman
- Pieber Thomas
- Pilger Ernst
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- Abstract:
- OBJECTIVE: Tight glycaemic control (TGC) in critically ill patients improves clinical outcome, but is difficult to establish The primary objective of the present study was to compare glucose control in medical ICU patients applying a computer-based enhanced model predictive control algorithm (eMPC) extended to include time-variant sampling against an implemented glucose management protocol. DESIGN: Open randomised controlled trial. SETTING: Nine-bed medical intensive care unit (ICU) in a tertiary teaching hospital. PATIENTS AND PARTICIPANTS: Fifty mechanically ventilated medical ICU patients. INTERVENTIONS: Patients were included for a study period of up to 72 h. Patients were randomised to the control group (n = 25), treated by an implemented insulin algorithm, or to the eMPC group (n = 25), using the laptop-based algorithm. Target range for blood glucose (BG) was 4.4-6.1 mM. Efficacy was assessed by mean BG, hyperglycaemic index (HGI) and BG sampling interval. Safety was assessed by the number of hypoglycaemic-episodes < 2.2 mM. Each participating nurse filled-in a questionnaire regarding the usability of the algorithm. MEASUREMENTS AND MAIN RESULTS: BG and HGI were significantly lower in the eMPC group [BG 5.9 mM (5.5-6.3), median (IQR); HGI 0.4 mM (0.2-0.9)] than in control patients [BG 7.4 mM (6.9-8.6), p < 0.001; HGI 1.6 mM (1.1-2.4), p < 0.001]. One hypoglycaemic episode was detected in the eMPC group; no such episodes in the control group. Sampling interval was significantly shorter in the eMPC group [eMPC 117[Symbol: see text]min (+/- 34), mean (+/- SD), vs 174 min (+/- 27); p < 0.001]. Thirty-four nurses filled-in the questionnaire. Thirty answered the question of whether the algorithm could be applied in daily routine in the affirmative. CONCLUSIONS: The eMPC algorithm was effective in maintaining tight glycaemic control in severely ill medical ICU patients.
- Find related publications in this database (using NLM MeSH Indexing)
- APACHE -
- Algorithms -
- Blood Glucose - drug effects
- Critical Care - methods
- Diabetes Mellitus, Type 1 - blood Diabetes Mellitus, Type 1 - classification Diabetes Mellitus, Type 1 - drug therapy
- Drug Therapy, Computer-Assisted - methods
- Female -
- Glycemic Index -
- Humans -
- Hypoglycemic Agents - administration and dosage Hypoglycemic Agents - therapeutic use
- Insulin - administration and dosage Insulin - therapeutic use
- Insulin Resistance -
- Intensive Care Units -
- Male -
- Middle Aged -
- Time Factors -
- Find related publications in this database (Keywords)
- critically ill
- insulin resistance
- tight glycemic control
- computer algorithm