Model-based insulin-nutrition administration for glycemic control in Malaysian critical care: First pilot trial

© 2018, Springer Science+Business Media Singapore. Stress-induced hyperglycemia is prevalent in critical care, even in patients with no history of diabetes. Control of blood glucose level with tight insulin therapy has been shown to reduce incidences of hyperglycemia leading to reduced mortality and improved clinical outcomes. STAR is a tablet-based glucose control protocol with a specialized user interface into which insulin and nutrition information can be entered and predicted. This research describes the first clinical pilot trial of STAR approach in International Islamic University Hospital, Kuantan, Malaysia. The clinically specified target for blood glucose level is between 4.4 and 8.0 mmol/L. Seven episodes (of 359 h) were recruited based on the need for glucose control. Overall, 43.93% of measurement are in the range of 4.4–8.0 mmol/L band. The blood glucose median is 8.30 [6.32–10.00] mmol/L with only 1 patient having below than 2.22 mmol/L which is the guaranteed minimum risk level. This pilot study shows that STAR protocol is a patient specific approach that provides a good glycemic control in critically ill patients. Nevertheless, its implementation in Malaysian intensive care environments requires modifications and improvements in certain areas

Physiological modeling, tight glycemic control, and the ICU clinician: what are models and how can they affect practice?

Critically ill patients are highly variable in their response to care and treatment. This variability and the search for improved outcomes have led to a significant increase in the use of protocolized care to reduce variability in care. However, protocolized care does not address the variability of outcome due to inter- and intra-patient variability, both in physiological state, and the response to disease and treatment. This lack of patient-specificity defines the opportunity for patient-specific approaches to diagnosis, care, and patient management, which are complementary to, and fit within, protocolized approaches

Towards personalized intensive care decision support using a Bayesian network: A multicenter glycemic control study

Personalized treatment in glycemic control (GC) is a visibly promising research area that requires improved mechanisms providing patient-specific procedures to enable complicated decision support. Available per-patient data must be more than written records, and be fully integrated in this personalization process. This article presents a process for relating the intensive care unit patients' demographic and admission data to their GC performance. With this objective, a probabilistic Bayesian network was chosen to provide more personalized decisions. As a case study, average daily blood glucose measurements were chosen as the interest target node in order to weigh GC that provides a reduced nursing workload. To test the idea, data from 482 patients, with nine variables from four Malaysian intensive care units with different controls were exploited. The identified steps crucial in building a dependable model are variable selection, continuous state discretization, and unsupervised structure learning. Using a multi-target node evaluation, a network with 80% mean overall classification precision was obtained with a normalized equal distance discretization algorithm and a maximum weight spanning tree technique. Meanwhile, the interest target node scored 90.39% precision. The results from this study, which are complemented with an evaluation of missing data, are proposed as a benchmark for using Bayesian networks in this type of application