Decision support for optimized blood glucose control and nutrition in a neurotrauma intensive care unit: preliminary results of clinical advice and prediction accuracy of the Glucosafe system.

Journal of Clinical Monitoring and Computing
Ulrike PielmeierPernille Haure

Abstract

Assessment of glycemic control with model-based decision support ("Glucosafe") in neurotrauma intensive care patients in an ongoing randomized controlled trial with a blood glucose (BG) target of 5-8 mmol/L. Assessment of BG prediction accuracy of the model and assessment of the effect that two potential model extensions would have on prediction accuracy in this trial. In the intervention group insulin infusion rates and nutrition are varied based on Glucosafe's decision support. In the control group, the caloric target is 25-30 kcal/kg per day and insulin is regulated according to department rules. BG concentrations, insulin infusion rates, and feed rates are compared from the data of 12 consecutive patients. BG measurements are predicted retrospectively and the mean relative prediction error is calculated using (1) the current model from the trial, (2) the current model modified by using a BG-dependent variable endogenous insulin appearance rate, (3) the current model modified by a patient-specific carbohydrate absorption factor. BG control was improved by Glucosafe. 76 % of BG measurements in Glucosafe patients were in the 5-8 mmol/L band (Controls: 51 %). BG means (log-normal) ± SD were 7.0 ± 1.19 mmol/L in Glucosafe patien...Continue Reading

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Citations

Aug 1, 2015·Journal of the American Medical Informatics Association : JAMIA·Anthony F WongAlan H Morris
Oct 29, 2014·Nature Reviews. Clinical Oncology·David G PoplackMarc E Horowitz
Nov 13, 2013·The Cochrane Database of Systematic Reviews·Florence GillaizeauPierre Durieux
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Mar 30, 2020·Journal of Clinical Monitoring and Computing·Aude de WattevilleClaudia-Paula Heidegger
Feb 18, 2021·Journal of the American Medical Informatics Association : JAMIA·Alan H MorrisDonald Berwick
Jul 10, 2009·The Cochrane Database of Systematic Reviews·Kaveh G ShojaniaJeremy Grimshaw

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