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Intensive insulin therapy: enhanced Model Predictive Control algorithm versus standard care.

Abstract：

OBJECTIVE:To investigate the effectiveness of an enhanced software Model Predictive Control (eMPC) algorithm for intravenous insulin infusion, targeted at tight glucose control in critically ill patients, over 72 h, in two intensive care units with different management protocols. DESIGN:Comparison with standard care in a two center open randomized clinical trial. SETTING:Two adult intensive care units in University Hospitals. PATIENTS AND PARTICIPANTS:Thirty-four critically ill patients with hyperglycaemia (glucose >120 mg/dL) or already receiving insulin infusion. INTERVENTIONS:Patients were randomized, within each ICU, to intravenous insulin infusion advised by eMPC algorithm or the ICU's standard insulin infusion administration regimen. MEASUREMENTS AND RESULTS:Arterial glucose concentration was measured at study entry and when advised by eMPC or measured as part of standard care. Time-weighted average glucose concentrations in patients receiving eMPC advised insulin infusions were similar [104 mg/dL (5.8 mmol/L)] in both ICUs. eMPC advised glucose measurement interval was significantly different between ICUs (1.1 vs. 1.8 h, P < 0.01). The standard care insulin algorithms resulted in significantly different time-weighted average glucose concentrations between ICUs [128 vs. 99 mg/dL (7.1 vs. 5.5 mmol/L), P < 0.01]. CONCLUSIONS:In this feasibility study the eMPC algorithm provided similar, effective and safe tight glucose control over 72 h in critically ill patients in two different ICUs. Further development is required to reduce glucose sampling interval while maintaining a low risk of hypoglycaemia.

journal_name

Intensive Care Med

journal_title

Intensive care medicine

authors

Cordingley JJ,Vlasselaers D,Dormand NC,Wouters PJ,Squire SD,Chassin LJ,Wilinska ME,Morgan CJ,Hovorka R,Van den Berghe G

doi

10.1007/s00134-008-1236-z

subject

Has Abstract

pub_date

2009-01-01 00:00:00

pages

123-8

issue

1

eissn

0342-4642

issn

1432-1238

journal_volume

35

pub_type

杂志文章,多中心研究,随机对照试验

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