5 research outputs found
Insulin + nutrition control for tight critical care glycaemic regulation
A new insulin and nutrition control method for tight glycaemic control in
critical care is presented from concept to clinical trials to clinical practice change. The
primary results show that the method can provide very tight glycaemic control in critical
care for a very critically ill cohort. More specifically, the final clinical practice change
protocol provided 2100 hours of control with average blood glucose of 5.8 +/- 0.9
mmol/L for an initial 10 patient pilot study. It also used less insulin, while providing the
same or greater nutritional input, as compared to retrospective hospital control for a
relatively very critically ill cohort with high insulin resistance
Grain Surface Models and Data for Astrochemistry
AbstractThe cross-disciplinary field of astrochemistry exists to understand the formation, destruction, and survival of molecules in astrophysical environments. Molecules in space are synthesized via a large variety of gas-phase reactions, and reactions on dust-grain surfaces, where the surface acts as a catalyst. A broad consensus has been reached in the astrochemistry community on how to suitably treat gas-phase processes in models, and also on how to present the necessary reaction data in databases; however, no such consensus has yet been reached for grain-surface processes. A team of ∼25 experts covering observational, laboratory and theoretical (astro)chemistry met in summer of 2014 at the Lorentz Center in Leiden with the aim to provide solutions for this problem and to review the current state-of-the-art of grain surface models, both in terms of technical implementation into models as well as the most up-to-date information available from experiments and chemical computations. This review builds on the results of this workshop and gives an outlook for future directions
Insulin + nutrition control for tight critical care glycaemic regulation
A new insulin and nutrition control method for tight glycaemic control in
critical care is presented from concept to clinical trials to clinical practice change. The
primary results show that the method can provide very tight glycaemic control in critical
care for a very critically ill cohort. More specifically, the final clinical practice change
protocol provided 2100 hours of control with average blood glucose of 5.8 +/- 0.9
mmol/L for an initial 10 patient pilot study. It also used less insulin, while providing the
same or greater nutritional input, as compared to retrospective hospital control for a
relatively very critically ill cohort with high insulin resistance
Clinical validation of a model-based glycaemic control design approach and comparison to other clinical protocols
Invited paper in special sessionHyperglycaemia is prevalent in critical care and
tight control can reduce mortality from 9-43% depending on
the level of control and the cohort. This research presents a
table-based method that varies both insulin dose and
nutritional input to achieve tight control. The system mimics a
previously validated model-based system, but can be used for
long term, large patient number clinical evaluation. This paper
evaluates this method in simulation using retrospective data
and then compares clinical measurements over 15,000 patient
hours to validate the models and development approach. This
validation thus also validates the in silico comparison to the
landmark clinical tight glycaemic control protocols. Overall, an
average clinical glucose level is 5.9 ± 1.0 mmol/L, matching
simulation, however the overall clinical glucose distribution is
slightly tighter than that obtained in simulation, indicating that
the retrospective virtual trial design approach is slightly
conservative. Finally, the model based approach is shown to
have tighter control than existing, more ad-hoc clinical
approaches based on the simulation results that qualitatively
match reported clinical results, but also show significant
variation around the average levels obtained in both the hypoand
hyper-glycaemic ranges
Tight glucose control in critically ill patients using a specialized insulin-nutrition table
Development implementation of the SPRINT protoco