LIVIVO - Search results -

Search results

Result 1 - 10 of total 21

Search options

Article ; Online: A survey on migraine attack treatment with the CEFALY

Penning, Sophie / Schoenen, Jean

2017 Volume 117, Issue 2, Page(s) 547–549

Language	English
Publishing date	2017
Publishing country	Italy
Document type	Letter
ZDB-ID	127315-2
ISSN	2240-2993 ; 0300-9009
ISSN (online)	2240-2993
ISSN	0300-9009
DOI	10.1007/s13760-017-0757-z
Database	MEDical Literature Analysis and Retrieval System OnLINE

Full text online

Accessible to users with ZB MED library card

In stock of ZB MED Cologne/Königswinter

Ui I Zs.57: Show issues

Location:
Je nach Verfügbarkeit (siehe Angabe bei Bestand)
bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular
ab Jg. 2022: Lesesaal (EG)

Order via subito

This service is chargeable due to the Delivery terms set by subito. Orders including an article and supplementary material will be classified as separate orders. In these cases, fees will be demanded for each order.

Details ▾

Article: Transcutaneous Supraorbital Nerve Stimulation (t-SNS) with the Cefaly

Riederer, Franz / Penning, Sophie / Schoenen, Jean

Pain and therapy

2015

Abstract: So far, among the different non-invasive neurostimulation methods, only transcutaneous supraorbital nerve stimulation (t-SNS) with the ... ...

Abstract	So far, among the different non-invasive neurostimulation methods, only transcutaneous supraorbital nerve stimulation (t-SNS) with the Cefaly
Language	English
Publishing date	2015-10-14
Publishing country	New Zealand
Document type	Journal Article
ZDB-ID	2701614-6
ISSN	2193-651X ; 2193-8237
ISSN (online)	2193-651X
ISSN	2193-8237
DOI	10.1007/s40122-015-0039-5
Database	MEDical Literature Analysis and Retrieval System OnLINE

Order via subito

Article ; Online: Glucose control positively influences patient outcome: A retrospective study.

Penning, Sophie / Pretty, Chris / Preiser, Jean-Charles / Shaw, Geoffrey M / Desaive, Thomas / Chase, J Geoffrey

Journal of critical care

2015 Volume 30, Issue 3, Page(s) 455–459

Abstract: Objective: The goal of this research is to demonstrate that well-regulated glycemia is beneficial to patient outcome, regardless of how it is achieved.: Methods: This analysis used data from 1701 patients from 2, independent studies. Glycemic outcome ...

Abstract	Objective: The goal of this research is to demonstrate that well-regulated glycemia is beneficial to patient outcome, regardless of how it is achieved. Methods: This analysis used data from 1701 patients from 2, independent studies. Glycemic outcome was measured using cumulative time in band (cTIB), calculated for 3 glycemic bands and for threshold values of t = 0.5, 0.6, 0.7, and 0.8. For each day of intensive care unit stay, patients were classified by cTIB, threshold, and hospital mortality, and odds of living (OL) and odds ratio were calculated. Results: The OL given cTIB ≥ t is higher than the OL given cTIB <t for all values of t, every day, for all 3 glycemic bands studied. The difference between the odds clearly increased over intensive care unit stay for t>0.6. Higher cTIB thresholds resulted in larger increases to odds ratio over time and were particularly significant for the 4.0 to 7.0 mmol/L glycemic band. Conclusion: Increased cTIB was associated with higher OL. These results suggest that effective glycemic control positively influences patient outcome, regardless of how the glycemic regulation is achieved. Blood glucose < 7.0 mmol/L is associated with a measurable increase in the odds of survival, if hypoglycemia is avoided.
MeSH term(s)	Blood Glucose/analysis ; Critical Care ; Female ; Hospital Mortality ; Humans ; Hyperglycemia/prevention & control ; Hypoglycemia/prevention & control ; Intensive Care Units ; Length of Stay ; Male ; Middle Aged ; Outcome Assessment (Health Care) ; Retrospective Studies
Chemical Substances	Blood Glucose
Language	English
Publishing date	2015-06
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	632818-0
ISSN	1557-8615 ; 0883-9441
ISSN (online)	1557-8615
ISSN	0883-9441
DOI	10.1016/j.jcrc.2014.12.013
Database	MEDical Literature Analysis and Retrieval System OnLINE

In stock of ZB MED Cologne/Königswinter

Zs.A 2152: Show issues

Location:
Je nach Verfügbarkeit (siehe Angabe bei Bestand)
bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
Jg. 1995 - 2021: Lesesall (1.OG)
ab Jg. 2022: Lesesaal (EG)

Order via subito

Details ▾
- See ZB MED holdings
- Order with fees

Article ; Online: Generalisability of a Virtual Trials Method for Glycaemic Control in Intensive Care.

Dickson, Jennifer L / Stewart, Kent W / Pretty, Christopher G / Flechet, Marine / Desaive, Thomas / Penning, Sophie / Lambermont, Bernard C / Benyo, Balazs / Shaw, Geoffrey M / Chase, J Geoffrey

IEEE transactions on bio-medical engineering

2017 Volume 65, Issue 7, Page(s) 1543–1553

Abstract: Background: Elevated blood glucose (BG) concentrations (Hyperglycaemia) are a common complication in critically ill patients. Insulin therapy is commonly used to treat hyperglycaemia, but metabolic variability often results in poor BG control and low BG ...

Abstract	Background: Elevated blood glucose (BG) concentrations (Hyperglycaemia) are a common complication in critically ill patients. Insulin therapy is commonly used to treat hyperglycaemia, but metabolic variability often results in poor BG control and low BG (hypoglycaemia). Objective: This paper presents a model-based virtual trial method for glycaemic control protocol design, and evaluates its generalisability across different populations. Methods: Model-based insulin sensitivity (SI) was used to create virtual patients from clinical data from three different ICUs in New Zealand, Hungary, and Belgium. Glycaemic results from simulation of virtual patients under their original protocol (self-simulation) and protocols from other units (cross simulation) were compared. Results: Differences were found between the three cohorts in median SI and inter-patient variability in SI. However, hour-to-hour intra-patient variability in SI was found to be consistent between cohorts. Self and cross-simulation results were found to have overall similarity and consistency, though results may differ in the first 24-48 h due to different cohort starting BG and underlying SI. Conclusions and significance: Virtual patients and the virtual trial method were found to be generalisable across different ICUs. This virtual trial method is useful for in silico protocol design and testing, given an understanding of the underlying assumptions and limitations of this method.
MeSH term(s)	Aged ; Blood Glucose/analysis ; Blood Glucose/physiology ; Computer Simulation ; Critical Illness ; Databases, Factual ; Female ; Humans ; Hyperglycemia/drug therapy ; Hyperglycemia/physiopathology ; Hyperglycemia/prevention & control ; Insulin/administration & dosage ; Insulin/pharmacokinetics ; Insulin/therapeutic use ; Insulin Resistance/physiology ; Male ; Middle Aged ; Models, Biological ; Retrospective Studies
Chemical Substances	Blood Glucose ; Insulin
Language	English
Publishing date	2017-03-24
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	160429-6
ISSN	1558-2531 ; 0018-9294
ISSN (online)	1558-2531
ISSN	0018-9294
DOI	10.1109/TBME.2017.2686432
Database	MEDical Literature Analysis and Retrieval System OnLINE

In stock of ZB MED Cologne/Königswinter

Zs.A 425: Show issues

Location:
Je nach Verfügbarkeit (siehe Angabe bei Bestand)
bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
Jg. 1995 - 2021: Lesesall (1.OG)
ab Jg. 2022: Lesesaal (EG)

Order via subito

Details ▾
- See ZB MED holdings
- Order with fees

Article ; Online: Interstitial insulin kinetic parameters for a 2-compartment insulin model with saturable clearance.

Pretty, Christopher G / Le Compte, Aaron / Penning, Sophie / Fisk, Liam / Shaw, Geoffrey M / Desaive, Thomas / Chase, J Geoffrey

Computer methods and programs in biomedicine

2014 Volume 114, Issue 3, Page(s) e39–45

Abstract: Glucose-insulin system models are commonly used for identifying insulin sensitivity. With physiological, 2-compartment insulin kinetics models, accurate kinetic parameter values are required for reliable estimates of insulin sensitivity. This study uses ... ...

Abstract	Glucose-insulin system models are commonly used for identifying insulin sensitivity. With physiological, 2-compartment insulin kinetics models, accurate kinetic parameter values are required for reliable estimates of insulin sensitivity. This study uses data from 6 published microdialysis studies to determine the most appropriate parameter values for the transcapillary diffusion rate (n(I)) and cellular insulin clearance rate (n(C)). The 6 studies (12 data sets) used microdialysis techniques to simultaneously obtain interstitial and plasma insulin concentrations. The reported plasma insulin concentrations were used as input and interstitial insulin concentrations were simulated with the interstitial insulin kinetics sub-model. These simulated results were then compared to the reported interstitial measurements and the most appropriate set of parameter values was determined across the 12 data sets by combining the results. Interstitial insulin kinetic parameters values n(I)=n(C)=0.0060 min⁻¹ were shown to be the most appropriate. These parameter values are associated with an effective, interstitial insulin half-life, t(½)=58 min, within the range of 25-130 min reported by others.
MeSH term(s)	Algorithms ; Blood Glucose/chemistry ; Computer Simulation ; Extracellular Fluid/metabolism ; Humans ; Insulin/blood ; Insulin/chemistry ; Kinetics ; Microdialysis ; Reproducibility of Results ; Software ; Time Factors
Chemical Substances	Blood Glucose ; Insulin
Language	English
Publishing date	2014-05
Publishing country	Ireland
Document type	Journal Article
ZDB-ID	632564-6
ISSN	1872-7565 ; 0169-2607
ISSN (online)	1872-7565
ISSN	0169-2607
DOI	10.1016/j.cmpb.2014.01.011
Database	MEDical Literature Analysis and Retrieval System OnLINE

In stock of ZB MED Cologne/Königswinter

Zs.B 521: Show issues

Location:
Je nach Verfügbarkeit (siehe Angabe bei Bestand)
bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular
ab Jg. 2022: Lesesaal (EG)

Order via subito

Details ▾
- See ZB MED holdings
- Order with fees

Article ; Online: Impact of sensor and measurement timing errors on model-based insulin sensitivity.

Pretty, Christopher G / Signal, Matthew / Fisk, Liam / Penning, Sophie / Le Compte, Aaron / Shaw, Geoffrey M / Desaive, Thomas / Chase, J Geoffrey

Computer methods and programs in biomedicine

2014 Volume 114, Issue 3, Page(s) e79–86

Abstract: A model-based insulin sensitivity parameter (SI) is often used in glucose-insulin system models to define the glycaemic response to insulin. As a parameter identified from clinical data, insulin sensitivity can be affected by blood glucose (BG) sensor ... ...

Abstract	A model-based insulin sensitivity parameter (SI) is often used in glucose-insulin system models to define the glycaemic response to insulin. As a parameter identified from clinical data, insulin sensitivity can be affected by blood glucose (BG) sensor error and measurement timing error, which can subsequently impact analyses or glycaemic variability during control. This study assessed the impact of both measurement timing and BG sensor errors on identified values of SI and its hour-to-hour variability within a common type of glucose-insulin system model. Retrospective clinical data were used from 270 patients admitted to the Christchurch Hospital ICU between 2005 and 2007 to identify insulin sensitivity profiles. We developed error models for the Abbott Optium Xceed glucometer and measurement timing from clinical data. The effect of these errors on the re-identified insulin sensitivity was investigated by Monte-Carlo analysis. The results of the study show that timing errors in isolation have little clinically significant impact on identified SI level or variability. The clinical impact of changes to SI level induced by combined sensor and timing errors is likely to be significant during glycaemic control. Identified values of SI were mostly (90th percentile) within 29% of the true value when influenced by both sources of error. However, these effects may be overshadowed by physiological factors arising from the critical condition of the patients or other under-modelled or un-modelled dynamics. Thus, glycaemic control protocols that are designed to work with data from glucometers need to be robust to these errors and not be too aggressive in dosing insulin.
MeSH term(s)	Aged ; Blood Glucose/analysis ; Blood Glucose/chemistry ; Computer Simulation ; Diabetes Mellitus/blood ; Female ; Humans ; Insulin/blood ; Insulin Resistance ; Male ; Medical Errors/prevention & control ; Middle Aged ; Monitoring, Physiologic/instrumentation ; Monte Carlo Method ; Probability ; Reproducibility of Results ; Retrospective Studies ; Software ; Time Factors
Chemical Substances	Blood Glucose ; Insulin
Language	English
Publishing date	2014-05
Publishing country	Ireland
Document type	Journal Article
ZDB-ID	632564-6
ISSN	1872-7565 ; 0169-2607
ISSN (online)	1872-7565
ISSN	0169-2607
DOI	10.1016/j.cmpb.2013.08.007
Database	MEDical Literature Analysis and Retrieval System OnLINE

In stock of ZB MED Cologne/Königswinter

Zs.B 521: Show issues

Location:
Je nach Verfügbarkeit (siehe Angabe bei Bestand)
bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular
ab Jg. 2022: Lesesaal (EG)

Order via subito

Details ▾
- See ZB MED holdings
- Order with fees

Article ; Online: Does the achievement of an intermediate glycemic target reduce organ failure and mortality? A post hoc analysis of the Glucontrol trial.

Penning, Sophie / Chase, J Geoffrey / Preiser, Jean-Charles / Pretty, Christopher G / Signal, Matthew / Mélot, Christian / Desaive, Thomas

Journal of critical care

2014 Volume 29, Issue 3, Page(s) 374–379

Abstract: Objective: This research evaluates the impact of the achievement of an intermediate target glycemic band on the severity of organ failure and mortality.: Methods: Daily Sequential Organ Failure Assessment (SOFA) score and the cumulative time in a 4.0 ...

Abstract	Objective: This research evaluates the impact of the achievement of an intermediate target glycemic band on the severity of organ failure and mortality. Methods: Daily Sequential Organ Failure Assessment (SOFA) score and the cumulative time in a 4.0 to 7.0 mmol/L band (cTIB) were evaluated daily up to 14 days in 704 participants of the multicentre Glucontrol trial (16 centers) that randomized patients to intensive group A (blood glucose [BG] target: 4.4-6.1 mmol/L) or conventional group B (BG target: 7.8-10.0 mmol/L). Sequential Organ Failure Assessment evolution was measured by percentage of patients with SOFA less than or equal to 5 on each day, percentage of individual organ failures, and percentage of organ failure-free days. Conditional and joint probability analysis of SOFA and cTIB 0.5 or more assessed the impact of achieving 4.0 to 7.0 mmol/L target glycemic range on organ failure. Odds ratios (OR) compare the odds risk of death for cTIB 0.5 or more vs cTIB less than 0.5, where a ratio greater than 1.0 indicates an improvement for achieving cTIB 0.5 or more independent of SOFA or glycemic target. Results: Groups A and B were matched for demographic and severity of illness data. Blood glucose differed between groups A and B (P<.05), as expected. There was no difference in the percentage of patients with SOFA less than or equal to 5, individual organ failures, and organ failure-free days between groups A and B over days 1 to 14. However, 20% to 30% of group A patients failed to achieve cTIB 0.5 or more for all days, and significant crossover confounds interpretation. Mortality OR was greater than 1.0 for patients with cTIB 0.5 or more in both groups but much higher for group A on all days. Conclusions: There was no difference in organ failure in the Glucontrol study based on intention to treat to different glycemic targets. Actual outcomes and significant crossover indicate that this result may not be due to the difference in target or treatment. Odds ratios-associated achieving an intermediate 4.0 to 7.0 mmol/L range improved outcome.
MeSH term(s)	Achievement ; Aged ; Blood Glucose/analysis ; Female ; Humans ; Male ; Middle Aged ; Multiple Organ Failure/blood ; Multiple Organ Failure/mortality ; Multiple Organ Failure/prevention & control ; Odds Ratio ; Organ Dysfunction Scores ; Prospective Studies
Chemical Substances	Blood Glucose
Language	English
Publishing date	2014-06
Publishing country	United States
Document type	Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	632818-0
ISSN	1557-8615 ; 0883-9441
ISSN (online)	1557-8615
ISSN	0883-9441
DOI	10.1016/j.jcrc.2014.01.013
Database	MEDical Literature Analysis and Retrieval System OnLINE

In stock of ZB MED Cologne/Königswinter

Zs.A 2152: Show issues

Location:
Je nach Verfügbarkeit (siehe Angabe bei Bestand)
bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
Jg. 1995 - 2021: Lesesall (1.OG)
ab Jg. 2022: Lesesaal (EG)

Order via subito

Details ▾
- See ZB MED holdings
- Order with fees

Article ; Online: Variability of insulin sensitivity during the first 4 days of critical illness: implications for tight glycemic control.

Pretty, Christopher G / Le Compte, Aaron J / Chase, J Geoffrey / Shaw, Geoffrey M / Preiser, Jean-Charles / Penning, Sophie / Desaive, Thomas

Annals of intensive care

2012 Volume 2, Issue 1, Page(s) 17

Abstract: Background: Effective tight glycemic control (TGC) can improve outcomes in critical care patients, but it is difficult to achieve consistently. Insulin sensitivity defines the metabolic balance between insulin concentration and insulin-mediated glucose ... ...

Abstract	Background: Effective tight glycemic control (TGC) can improve outcomes in critical care patients, but it is difficult to achieve consistently. Insulin sensitivity defines the metabolic balance between insulin concentration and insulin-mediated glucose disposal. Hence, variability of insulin sensitivity can cause variable glycemia. This study quantifies and compares the daily evolution of insulin sensitivity level and variability for critical care patients receiving TGC. Methods: This is a retrospective analysis of data from the SPRINT TGC study involving patients admitted to a mixed medical-surgical ICU between August 2005 and May 2007. Only patients who commenced TGC within 12 hours of ICU admission and spent at least 24 hours on the SPRINT protocol were included (N = 164). Model-based insulin sensitivity (SI) was identified each hour. Absolute level and hour-to-hour percent changes in SI were assessed on cohort and per-patient bases. Levels and variability of SI were compared over time on 24-hour and 6-hour timescales for the first 4 days of ICU stay. Results: Cohort and per-patient median SI levels increased by 34% and 33% (p < 0.001) between days 1 and 2 of ICU stay. Concomitantly, cohort and per-patient SI variability decreased by 32% and 36% (p < 0.001). For 72% of the cohort, median SI on day 2 was higher than on day 1. The day 1-2 results are the only clear, statistically significant trends across both analyses. Analysis of the first 24 hours using 6-hour blocks of SI data showed that most of the improvement in insulin sensitivity level and variability seen between days 1 and 2 occurred during the first 12-18 hours of day 1. Conclusions: Critically ill patients have significantly lower and more variable insulin sensitivity on day 1 than later in their ICU stay and particularly during the first 12 hours. This rapid improvement is likely due to the decline of counter-regulatory hormones as the acute phase of critical illness progresses. Clinically, these results suggest that while using TGC protocols with patients during their first few days of ICU stay, extra care should be afforded. Increased measurement frequency, higher target glycemic bands, conservative insulin dosing, and modulation of carbohydrate nutrition should be considered to minimize safely the outcome glycemic variability and reduce the risk of hypoglycemia.
Language	English
Publishing date	2012-06-15
Publishing country	Germany
Document type	Journal Article
ZDB-ID	2617094-2
ISSN	2110-5820 ; 2110-5820
ISSN (online)	2110-5820
ISSN	2110-5820
DOI	10.1186/2110-5820-2-17
Database	MEDical Literature Analysis and Retrieval System OnLINE

Order via subito

Article ; Online: STAR development and protocol comparison.

Fisk, Liam M / Le Compte, Aaron J / Shaw, Geoffrey M / Penning, Sophie / Desaive, Thomas / Chase, J Geoffrey

IEEE transactions on bio-medical engineering

2012 Volume 59, Issue 12, Page(s) 3357–3364

Abstract: Accurate glycemic control (AGC) is difficult due to excessive hypoglycemia risk. Stochastic TARgeted (STAR) glycemic control forecasts changes in insulin sensitivity to calculate a range of glycemic outcomes for an insulin intervention, creating a risk ... ...

Abstract	Accurate glycemic control (AGC) is difficult due to excessive hypoglycemia risk. Stochastic TARgeted (STAR) glycemic control forecasts changes in insulin sensitivity to calculate a range of glycemic outcomes for an insulin intervention, creating a risk framework to improve safety and performance. An improved, simplified STAR framework was developed to reduce light hypoglycemia and clinical effort, while improving nutrition rates and performance. Blood glucose (BG) levels are targeted to 80-145 mg/dL, using insulin and nutrition control for 1-3 h interventions. Insulin changes are limited to +3U/h and nutrition to ±30% of goal rate (minimum 30%). All targets and rate change limits are clinically specified and generalizable. Clinically validated virtual trials were run on using clinical data from 371 patients (39841 h) from the Specialized Relative Insulin and Nutrition Tables (SPRINT) cohort. Cohort and per-patient results are compared to clinical SPRINT data, and virtual trials of three published protocols. Performance was measured as time within glycemic bands, and safety by patients with severe (BG < 40 mg/dL) and mild (%BG < 72 mg/dL) hypoglycemia. Pilot trial results from the first ten patients (1486 h) are included to support the in-silico findings. In both virtual and clinical trials, mild hypoglycemia was below 2% versus 4% for SPRINT. Severe hypoglycemia was reduced from 14 (SPRINT) to 6 (STAR), and 0 in the pilot trial. AGC was tighter than both SPRINT clinical data and in-silico comparison protocols, with 91% BG within the specified target (80-145 mg/dL) in virtual trials and 89.4% in pilot trials. Clinical effort (measurements) was reduced from 16.2/day to 11.8/day (13.5/day in pilot trials). This STAR framework provides safe AGC with significant reductions in hypoglycemia and clinical effort due to stochastic forecasting of patient variation-a unique risk-based approach. Initial pilot trials validate the in-silico design methods and resulting protocol, all of which can be generalized to suit any given clinical environment.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Algorithms ; Blood Glucose/analysis ; Blood Glucose/drug effects ; Blood Glucose/metabolism ; Clinical Trials as Topic ; Cohort Studies ; Computer Simulation ; Female ; Humans ; Hypoglycemia/blood ; Hypoglycemia/prevention & control ; Hypoglycemic Agents/administration & dosage ; Insulin/administration & dosage ; Male ; Middle Aged ; Models, Biological ; Reproducibility of Results ; Signal Processing, Computer-Assisted
Chemical Substances	Blood Glucose ; Hypoglycemic Agents ; Insulin
Language	English
Publishing date	2012-12
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	160429-6
ISSN	1558-2531 ; 0018-9294
ISSN (online)	1558-2531
ISSN	0018-9294
DOI	10.1109/TBME.2012.2214384
Database	MEDical Literature Analysis and Retrieval System OnLINE

In stock of ZB MED Cologne/Königswinter

Zs.A 425: Show issues

Location:
Je nach Verfügbarkeit (siehe Angabe bei Bestand)
bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
Jg. 1995 - 2021: Lesesall (1.OG)
ab Jg. 2022: Lesesaal (EG)

Order via subito

Details ▾
- See ZB MED holdings
- Order with fees

Article ; Online: First pilot trial of the STAR-Liege protocol for tight glycemic control in critically ill patients.

Penning, Sophie / Le Compte, Aaron J / Moorhead, Katherine T / Desaive, Thomas / Massion, Paul / Preiser, Jean-Charles / Shaw, Geoffrey M / Chase, J Geoffrey

Computer methods and programs in biomedicine

2012 Volume 108, Issue 2, Page(s) 844–859

Abstract: Tight glycemic control (TGC) has shown benefits in ICU patients, but been difficult to achieve consistently due to inter- and intra- patient variability that requires more adaptive, patient-specific solutions. STAR (Stochastic TARgeted) is a flexible ... ...

Abstract	Tight glycemic control (TGC) has shown benefits in ICU patients, but been difficult to achieve consistently due to inter- and intra- patient variability that requires more adaptive, patient-specific solutions. STAR (Stochastic TARgeted) is a flexible model-based TGC framework accounting for patient variability with a stochastically derived maximum 5% risk of blood glucose (BG) below 72 mg/dL. This research describes the first clinical pilot trial of the STAR approach and the post-trial analysis of the models and methods that underpin the protocol. The STAR framework works with clinically specified targets and intervention guidelines. The clinically specified glycemic target was 125 mg/dL. Each trial was 24 h with BG measured 1-2 hourly. Two-hourly measurement was used when BG was between 110-135 mg/dL for 3 h. In the STAR approach, each intervention leads to a predicted BG level and outcome range (5-95th percentile) based on a stochastic model of metabolic patient variability. Carbohydrate intake (all sources) was monitored, but not changed from clinical settings except to prevent BG<100 mg/dL when no insulin was given. Insulin infusion rates were limited (6 U/h maximum), with limited increases based on current infusion rate (0.5-2.0 U/h), making this use of the STAR framework an insulin-only TGC approach. Approval was granted by the Ethics Committee of the Medical Faculty of the University of Liege (Liege, Belgium). Nine patient trials were undertaken after obtaining informed consent. There were 205 measurements over all 9 trials. Median [IQR] per-patient results were: BG: 138.5 [130.6-146.0]mg/dL; carbohydrate administered: 2-11 g/h; median insulin:1.3 [0.9-2.4]U/h with a maximum of 6.0 [4.7-6.0]U/h. Median [IQR] time in the desired 110-140 mg/dL band was: 50.0 [31.2-54.2]%. Median model prediction errors ranged: 10-18%, with larger errors due to small meals and other clinical events. The minimum BG was 63 mg/dL and no other measurement was below 72 mg/dL, so only 1 measurement (0.5%) was below the 5% guaranteed minimum risk level. Post-trial analysis showed that patients were more variable than predicted by the stochastic model used for control, resulting in some of the prediction errors seen. Analysis and (validated) virtual trial re-simulating the clinical trial using stochastic models relevant to the patient's particular day of ICU stay were seen to be more accurate in capturing the observed variability. This analysis indicated that equivalent control and safety could be obtained with similar or lower glycemic variability in control using more specific stochastic models. STAR effectively controlled all patients to target. Observed patient variability in response to insulin and thus prediction errors were higher than expected, likely due to the recent insult of cardiac surgery or a major cardiac event, and their immediate recovery. STAR effectively managed this variability with no hypoglycemia. Improved stochastic models will be used to prospectively test these outcomes in further ongoing clinical pilot trials in this and other units.
MeSH term(s)	Blood Glucose/analysis ; Clinical Protocols ; Critical Illness ; Female ; Humans ; Male ; Pilot Projects ; Stochastic Processes
Chemical Substances	Blood Glucose
Language	English
Publishing date	2012-11
Publishing country	Ireland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	632564-6
ISSN	1872-7565 ; 0169-2607
ISSN (online)	1872-7565
ISSN	0169-2607
DOI	10.1016/j.cmpb.2011.07.003
Database	MEDical Literature Analysis and Retrieval System OnLINE

In stock of ZB MED Cologne/Königswinter

Zs.B 521: Show issues

Location:
Je nach Verfügbarkeit (siehe Angabe bei Bestand)
bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular
ab Jg. 2022: Lesesaal (EG)

Order via subito

Details ▾
- See ZB MED holdings
- Order with fees

To top

Full text online

More links

Kategorien

In stock of ZB MED Cologne/Königswinter

Order via subito

More links

Kategorien

Order via subito

More links

Kategorien

In stock of ZB MED Cologne/Königswinter

Order via subito

More links

Kategorien

In stock of ZB MED Cologne/Königswinter

Order via subito

More links

Kategorien

In stock of ZB MED Cologne/Königswinter

Order via subito

More links

Kategorien

In stock of ZB MED Cologne/Königswinter

Order via subito

More links

Kategorien

In stock of ZB MED Cologne/Königswinter

Order via subito

More links

Kategorien

Order via subito

More links

Kategorien

In stock of ZB MED Cologne/Königswinter

Order via subito

More links

Kategorien

In stock of ZB MED Cologne/Königswinter

Order via subito