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    Development and optimisation of stochastic targeted (STAR) glycaemic control for neonatal intensive care (2012)

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    Type of Content
    Conference Contributions - Published
    UC Permalink
    http://hdl.handle.net/10092/7339
    
    Publisher's DOI/URI
    https://doi.org/10.3182/20120829-3-HU-2029.00034
    
    Publisher
    University of Canterbury. Mechanical Engineering
    Collections
    • Engineering: Conference Contributions [2296]
    Authors
    Dickson, J.L.
    Le Compte, A.J.
    Floyd, R.P.
    Chase, Geoff cc
    Lynn, A.
    Shaw, Geoff cc
    show all
    Abstract

    Hyperglycaemia is a common complication of prematurity and stress in neonatal intensive care units (NICUs). It has been linked to worsened outcomes and mortality. There is currently no universally accepted best practice glycaemic control method, with many protocols lacking patient specificity and relying heavily on clinical judgment. The result is persistent hypoglycaemia and poor control. This research presents the virtual trial design and optimisation of a stochastic targeted (STAR) approach to improve performance and reduce hypoglycaemia. Clinically validated virtual trials based on NICU patient data (N = 61 patients, 7006 hours) are used to develop and optimise a STAR protocol that improves on current STAR-NICU performance and reduce hypoglycaemia. Five approaches are used to maximize the stochastic range of BG outcomes within 4.0-8.0mmol/L, and are designed based on an overall cohort risk to provide clinically specified risk (5%) of BG above or below a clinically specified level. The best protocol placed the 5th percentile BG outcome for an intervention on 4.0mmol/L band. The optimised protocol increased %BG in the 4.0-8.0mmol/L band by 7% and the incidence of BG<2.6mmol/L by 1 patient (50%). Significant intra- and inter- patient variability reduced possible performance gains, indicating a need for patient-specific or sub-cohort specific approaches to manage variability.

    Citation
    Dickson, J.L., Le Compte, A.J., Floyd, R.P., Chase, J.G., Lynn, A., Shaw, G.M. (2012) Development and optimisation of stochastic targeted (STAR) glycaemic control for neonatal intensive care. Budapest, Hungary: 8th IFAC Symposium on Biological and Medical Systems (BMS12), 29-31 Aug 2012. Biological and Medical Systems, 8, 1, 319-324.
    This citation is automatically generated and may be unreliable. Use as a guide only.
    Keywords
    insulin sensitivity; control algorithms; physiological models; simulation; intensive care
    ANZSRC Fields of Research
    32 - Biomedical and clinical sciences::3202 - Clinical sciences::320208 - Endocrinology
    32 - Biomedical and clinical sciences::3202 - Clinical sciences::320212 - Intensive care
    11 - Medical and Health Sciences::1114 - Paediatrics and Reproductive Medicine::111403 - Paediatrics
    Rights
    https://hdl.handle.net/10092/17651

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    • On the problem of patient specific endogenous glucose production in neonates on stochastic targeted (STAR) glycaemic control 

      Dickson, J.L.; Hewett, J.N.; Gunn, C.A.; Lynn, A.; Shaw, Geoff; Chase, Geoff; Dickson, J.L. (University of Canterbury. Mechanical Engineering, 2013)
      Background: Stress and prematurity can both induce hyperglycaemia in the neonatal intensive care unit (NICU), which in turn is associated with worsened outcomes. Endogenous glucose production (EGP) is the formation of ...
    • Performance and Safety of STAR Glycaemic Control in Neonatal Intensive Care: Further Clinical Results Including Pilot Results from a New Protocol Implementation 

      Dickson, J.L.; Lynn, A.; Gunn, C.A.; Le Compte, A.; Fisk, L.; Shaw, Geoff; Chase, Geoff (University of Canterbury. Chemical and Process EngineeringUniversity of Canterbury. Mechanical Engineering, 2014)
      Elevated blood glucose concentrations (BG) (Hyperglycaemia) are a common complication of prematurity in extremely low birth weight neonates in the neonatal intensive care unit (NICU), and are associated with increased ...
    • Development and optimisation of stochastic targeted (STAR) glycaemic control for pre-term infants in neonatal intensive care 

      Dickson, J.L.; Le Compte, A.J.; Floyd, R.P.; Chase, Geoff; Lynn, A.; Shaw, Geoff (University of Canterbury. Chemical and Process EngineeringUniversity of Canterbury. Mechanical Engineering, 2013)
      Hyperglycaemia is a common complication of prematurity and stress in neonatal intensive care units (NICUs). It has been linked to worsened outcomes and mortality. There is currently no universally accepted best practice ...
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