Intensive insulin therapy: enhanced Model Predictive Control algorithm versus standard care
Intensive insulin therapy: enhanced Model Predictive Control algorithm versus standard care
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DOI：
10.1007/s00134-008-1236-z
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发表时间：
2009-01-01
影响因子：
38.9
通讯作者：
Van den Berghe, Greet
中科院分区：
文献类型：
--
作者：
Cordingley, Jeremy J.;Vlasselaers, Dirk;Van den Berghe, Greet
研究增强型软件模型预测控制（eMPC）算法用于静脉胰岛素输注的有效性，旨在对危重患者进行72小时以上的严格血糖控制，在两个重症监护病房采用不同的管理方案。在两个中心的开放随机临床试验中与标准护理进行比较。在大学医院的两个成人重症监护病房。34例高血糖症危重患者在每个ICU内，将患者随机分配至由eMPC算法建议的静脉内胰岛素输注或ICU的标准胰岛素输注给药方案。在研究进入时和由eMPC建议时测量动脉葡萄糖浓度或作为标准护理的一部分测量动脉葡萄糖浓度。两个ICU中接受eMPC建议胰岛素输注的患者的时间加权平均葡萄糖浓度相似[104 mg/dL（5.8 mmol/L）]。eMPC建议的血糖测量间隔时间在ICU之间有显著差异（1.1 vs. 1.8 h，P < 0.01）。标准治疗胰岛素算法导致ICU之间的时间加权平均葡萄糖浓度显著不同[128 vs. 99 mg/dL（7.1 vs. 5.5 mmol/L），P < 0.01]。在这项可行性研究中，eMPC算法在两个不同ICU的危重患者中提供了相似、有效和安全的72小时严格葡萄糖控制。需要进一步开发，以缩短血糖采样间隔，同时保持低血糖风险较低。
To investigate the effectiveness of an enhanced software Model Predictive Control (eMPC) algorithm for intravenous insulin infusion, targeted at tight glucose control in critically ill patients, over 72 h, in two intensive care units with different management protocols.Comparison with standard care in a two center open randomized clinical trial.Two adult intensive care units in University Hospitals.Thirty-four critically ill patients with hyperglycaemia (glucose > 120 mg/dL) or already receiving insulin infusion.Patients were randomized, within each ICU, to intravenous insulin infusion advised by eMPC algorithm or the ICU's standard insulin infusion administration regimen.Arterial glucose concentration was measured at study entry and when advised by eMPC or measured as part of standard care. Time-weighted average glucose concentrations in patients receiving eMPC advised insulin infusions were similar [104 mg/dL (5.8 mmol/L)] in both ICUs. eMPC advised glucose measurement interval was significantly different between ICUs (1.1 vs. 1.8 h, P < 0.01). The standard care insulin algorithms resulted in significantly different time-weighted average glucose concentrations between ICUs [128 vs. 99 mg/dL (7.1 vs. 5.5 mmol/L), P < 0.01].In this feasibility study the eMPC algorithm provided similar, effective and safe tight glucose control over 72 h in critically ill patients in two different ICUs. Further development is required to reduce glucose sampling interval while maintaining a low risk of hypoglycaemia.