Development and optimisation of stochastic targeted (STAR) glycaemic control for neonatal intensive care (2012)
Type of ContentConference Contributions - Published
PublisherUniversity of Canterbury. Mechanical Engineering
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.
CitationDickson, 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.
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Keywordsinsulin sensitivity; control algorithms; physiological models; simulation; intensive care
ANZSRC Fields of Research32 - 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
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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 ...
Floyd, R.P.; Dickson, J.L.; Le Compte, A.J.; Chase, Geoff; Lynn, A.; Shaw, Geoff (University of Canterbury. Mechanical Engineering, 2012)Hyperglycaemia is a prevalent complication in the neonatal intensive care unit (NICU) and is associated with worsened outcomes. It occurs as a result of prematurity, under developed endogenous glucose regulatory systems ...