2 research outputs found
Overview of Glycemic Control in Critical Care - Relating Performance and Clinical Results
Inagural review article invited for inaugural journalBackground: Hyperglycemia is prevalent in critical care and tight control can save
lives. Current ad-hoc clinical protocols require significant clinical effort and produce
highly variable results. Model-based methods can provide tight, patient specific
control, while addressing practical clinical difficulties and dynamic patient evolution.
However, tight control remains elusive as there is not enough understanding of the
relationship between control performance and clinical outcome.
Methods: The general problem and performance criteria are defined. The clinical
studies performed to date using both ad-hoc titration and model-based methods are
reviewed. Studies reporting mortality outcome are analysed in terms of standardized
mortality ratio (SMR) and a 95th percentile (Ā±2 ) standard error (SE95%) to enable
better comparison across cohorts.
Results: Model-based control trials lower blood glucose into a 72-110mg/dL band
within 10 hours, have target accuracy over 90%, produce fewer hypoglycemic
episodes, and require no additional clinical intervention. Plotting SMR versus SE95%
shows potentially high correlation (r=0.84) between ICU mortality and tightness of
control.
Summary: Model-based methods provide tighter, more adaptable āone method fits
allā solutions, using methods that enable patient-specific modeling and control.
Correlation between tightness of control and clinical outcome suggests that
performance metrics, such as time in a relevant glycemic band, may provide better
guidelines. Overall, compared to current āone size fits allā sliding scale and ad-hoc
regimens, patient-specific pharmacodynamic and pharmacokinetic model-based, or
āone method fits allā, control, utilizing computational and emerging sensor
technologies, offers improved treatment and better potential outcomes when treating
hyperglycemia in the highly dynamic critically ill patient
Overview of Glycemic Control in Critical Care - Relating Performance and Clinical Results
Inagural review article invited for inaugural journalBackground: Hyperglycemia is prevalent in critical care and tight control can save
lives. Current ad-hoc clinical protocols require significant clinical effort and produce
highly variable results. Model-based methods can provide tight, patient specific
control, while addressing practical clinical difficulties and dynamic patient evolution.
However, tight control remains elusive as there is not enough understanding of the
relationship between control performance and clinical outcome.
Methods: The general problem and performance criteria are defined. The clinical
studies performed to date using both ad-hoc titration and model-based methods are
reviewed. Studies reporting mortality outcome are analysed in terms of standardized
mortality ratio (SMR) and a 95th percentile (Ā±2 ) standard error (SE95%) to enable
better comparison across cohorts.
Results: Model-based control trials lower blood glucose into a 72-110mg/dL band
within 10 hours, have target accuracy over 90%, produce fewer hypoglycemic
episodes, and require no additional clinical intervention. Plotting SMR versus SE95%
shows potentially high correlation (r=0.84) between ICU mortality and tightness of
control.
Summary: Model-based methods provide tighter, more adaptable āone method fits
allā solutions, using methods that enable patient-specific modeling and control.
Correlation between tightness of control and clinical outcome suggests that
performance metrics, such as time in a relevant glycemic band, may provide better
guidelines. Overall, compared to current āone size fits allā sliding scale and ad-hoc
regimens, patient-specific pharmacodynamic and pharmacokinetic model-based, or
āone method fits allā, control, utilizing computational and emerging sensor
technologies, offers improved treatment and better potential outcomes when treating
hyperglycemia in the highly dynamic critically ill patient