Tight Glycemic Control in Intensive Care: From engineering to clinical practice change (2011)
AuthorsChase, J.G., Le Compte, A.J., Evans, A., Ward, L., Steel, J., Tan, C-S., Pretty, C.G., Penning, S., Desaive, T., Shaw, G.M.show all
Tight glycemic control (TGC) is prevalent in critical care. Providing safe, effective TGC has proven very difficult to achieve with clinically derived protocols. The prob-lem is exacerbated by extreme patient variability and the need to minimize clinical effort and burden. These ingredients make an ideal scenario for model-based methods to provide opti-mised solutions. This paper presents the development, clinical-ly validated virtual trials optimisation, and initial clinical implementation of a stochastic targeted (STAR) TGC method and framework. It is compared to a prior successful, model-derived, less flexible and dynamic TGC protocol (SPRINT). The use of stochastic models to safely forecast a range of glu-cose outcomes over 1-3 hours ensures better performance, more dynamic use of the range of insulin and nutrition inputs and thus better glycemic performance and safety from hypog-lycemia, the latter of which was reduced by 3.0x times. Hence, the paper presents an overall engineering approach to TGC from engineering models to clinical implementation and ongo-ing clinical practice change
CitationChase, J.G., Le Compte, A.J., Evans, A., Ward, L., Steel, J., Tan, C-S., Pretty, C.G., Penning, S., Desaive, T., Shaw, G.M. (2011) Tight Glycemic Control in Intensive Care: From engineering to clinical practice change. Budapest, Hungary: 5th European Conference of IFMBE for Medical and Biological Engineering (MBEC), 14-18 Sep 2011. 4pp.
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