Multicentric, Randomized, Controlled Trial to Evaluate Blood Glucose Control by the Model Predictive Control Algorithm Versus Routine Glucose Management Protocols in Intensive Care Unit Patients
| Autor: | Andreas Plasnik, S Squire, Wolfgang Toller, Roman Hovorka, Malgorzata E. Wilinska, J Kremen, Cliff Morgan, Stepan Svacina, Martin Ellmerer, Jeremy J. Cordingley, Jan Bláha, Johannes Plank, Thomas R. Pieber, Martin Haluzik, Ludovic J. Chassin |
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| Rok vydání: | 2006 |
| Předmět: |
Blood Glucose
Male medicine.medical_specialty Heart Diseases Critical Illness Endocrinology Diabetes and Metabolism Carbohydrates law.invention Randomized controlled trial law Intensive care Diabetes mellitus Internal Medicine Humans Hypoglycemic Agents Insulin Medicine Aged Monitoring Physiologic Glycemic Postoperative Care Advanced and Specialized Nursing business.industry medicine.disease Intensive care unit Hypoglycemia Glucose management Cardiac surgery Intensive Care Units Model predictive control Female business Algorithm Algorithms |
| Zdroj: | Scopus-Elsevier |
| ISSN: | 1935-5548 0149-5992 |
| DOI: | 10.2337/diacare.29.02.06.dc05-1689 |
| Popis: | OBJECTIVE—To evaluate a fully automated algorithm for the establishment of tight glycemic control in critically ill patients and to compare the results with different routine glucose management protocols of three intensive care units (ICUs) across Europe (Graz, Prague, and London). RESEARCH DESIGN AND METHODS—Sixty patients undergoing cardiac surgery (age 67 ± 9 years, BMI 27.7 ± 4.9 kg/m2, 17 women) with postsurgery blood glucose levels >120 mg/dl (6.7 mmol/l) were investigated in three different ICUs (20 per center). Patients were randomized to either blood glucose management (target range 80–110 mg/dl [4.4–6.1 mmol/l]) by the fully automated model predictive control (MPC) algorithm (n = 30, 10 per center) or implemented routine glucose management protocols (n = 30, 10 per center). In all patients, arterial glucose was measured hourly to describe the glucose profile until the end of the ICU stay but for a maximum period of 48 h. RESULTS—Compared with routine protocols, MPC treatment resulted in a significantly higher percentage of time within the target glycemic range (% median [min–max]: 52 [17–92] vs. 19 [0–71]) over 0–24 h (P < 0.01). Improved glycemic control with MPC treatment was confirmed in patients remaining in the ICU for 48 h (0–24 h: 50 [17–71] vs. 21 [4–67], P < 0.05, and 24–48 h: 65 [38–96] vs. 25 [8–79], P < 0.05, for MPC [n = 16] vs. routine protocol [n = 13], respectively). Two hypoglycemic events ( CONCLUSIONS—The data suggest that the MPC algorithm is safe and effective in controlling glycemia in critically ill postsurgery patients. |
| Databáze: | OpenAIRE |
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