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https://www.readbyqxmd.com/read/28226967/nonlinear-model-predictive-glycemic-control-of-critically-ill-patients-using-online-identification-of-insulin-sensitivity
#1
Sha Wu, Eiko Furutani, Sha Wu, Eiko Furutani, Eiko Furutani, Sha Wu
In critically ill patients suffering from hyperglycemia, it has been recently shown that mortality and morbidity can be reduced by keeping blood glucose within the range of 80-110 mg/dL. However, maintaining glycemia within such range is difficult due to the time variability in insulin sensitivity in critically ill patients. In this paper, we propose a novel glycometabolism model of critically ill patients with an insulin sensitivity parameter and develop a nonlinear model predictive glycemic control system with online identification of insulin sensitivity at one-hour intervals...
August 2016: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
https://www.readbyqxmd.com/read/28224103/management-of-parenteral-nutrition-in-critically-ill-patients
#2
REVIEW
Paolo Cotogni
Artificial nutrition (AN) is necessary to meet the nutritional requirements of critically ill patients at nutrition risk because undernutrition determines a poorer prognosis in these patients. There is debate over which route of delivery of AN provides better outcomes and lesser complications. This review describes the management of parenteral nutrition (PN) in critically ill patients. The first aim is to discuss what should be done in order that the PN is safe. The second aim is to dispel "myths" about PN-related complications and show how prevention and monitoring are able to reach the goal of "near zero" PN complications...
February 4, 2017: World Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28215130/exogenous-glucagon-like-peptide-1-attenuates-glucose-absorption-and-reduces-blood-glucose-concentration-after-small-intestinal-glucose-delivery-in-critical-illness
#3
Asaf Miller, Adam M Deane, Mark P Plummer, Caroline E Cousins, Lee-Anne S Chapple, Michael Horowitz, Marianne J Chapman
OBJECTIVE: To evaluate the effect of exogenous glucagonlike peptide-1 (GLP-1) on small intestinal glucose absorption and blood glucose concentrations during critical illness. DESIGN, SETTING AND PARTICIPANTS: A prospective, blinded, placebo-controlled, cross-over, randomised trial in a mixed medical-surgical adult intensive care unit, with 12 mechanically ventilated critically ill patients, who were suitable for receiving small intestinal nutrient. INTERVENTIONS: On consecutive days, in a randomised order, participants received intravenous GLP-1 (1...
March 2017: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
https://www.readbyqxmd.com/read/28118549/tight-glycemic-control-in-critically-ill-children
#4
Michael S D Agus, David Wypij, Eliotte L Hirshberg, Vijay Srinivasan, E Vincent Faustino, Peter M Luckett, Jamin L Alexander, Lisa A Asaro, Martha A Q Curley, Garry M Steil, Vinay M Nadkarni
Background In multicenter studies, tight glycemic control targeting a normal blood glucose level has not been shown to improve outcomes in critically ill adults or children after cardiac surgery. Studies involving critically ill children who have not undergone cardiac surgery are lacking. Methods In a 35-center trial, we randomly assigned critically ill children with confirmed hyperglycemia (excluding patients who had undergone cardiac surgery) to one of two ranges of glycemic control: 80 to 110 mg per deciliter (4...
February 23, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28098809/the-clinical-benefits-and-accuracy-of-continuous-glucose-monitoring-systems-in-critically-ill-patients-a-systematic-scoping-review
#5
REVIEW
Sigrid C J van Steen, Saskia Rijkenberg, Jacqueline Limpens, Peter H J van der Voort, Jeroen Hermanides, J Hans DeVries
Continuous Glucose Monitoring (CGM) systems could improve glycemic control in critically ill patients. We aimed to identify the evidence on the clinical benefits and accuracy of CGM systems in these patients. For this, we performed a systematic search in Ovid MEDLINE, from inception to 26 July 2016. Outcomes were efficacy, accuracy, safety, workload and costs. Our search retrieved 356 articles, of which 37 were included. Randomized controlled trials on efficacy were scarce (n = 5) and show methodological limitations...
January 14, 2017: Sensors
https://www.readbyqxmd.com/read/28072822/point-of-care-versus-central-laboratory-measurements-of-hemoglobin-hematocrit-glucose-bicarbonate-and-electrolytes-a-prospective-observational-study-in-critically-ill-patients
#6
Jérôme Allardet-Servent, Melissa Lebsir, Christian Dubroca, Martine Fabrigoule, Sylvie Jordana, Thomas Signouret, Matthias Castanier, Guillemette Thomas, Rettinavelou Soundaravelou, Anne Lepidi, Laurence Delapierre, Guillaume Penaranda, Philippe Halfon, Jean-Marie Seghboyan
INTRODUCTION: Rapid detection of abnormal biological values using point-of-care (POC) testing allows clinicians to promptly initiate therapy; however, there are concerns regarding the reliability of POC measurements. We investigated the agreement between the latest generation blood gas analyzer and central laboratory measurements of electrolytes, bicarbonate, hemoglobin, hematocrit, and glucose. METHODS: 314 paired samples were collected prospectively from 51 critically ill patients...
2017: PloS One
https://www.readbyqxmd.com/read/28067472/efficacy-of-basal-bolus-insulin-regimens-in-the-inpatient-management-of-non-critically-ill-patients-with-type-2-diabetes-a-systematic-review-and-meta-analysis
#7
REVIEW
Merete B Christensen, Anders Gotfredsen, Kirsten Nørgaard
BACKGROUND: Hyperglycemia during hospitalization is associated with increased rates of complications and longer hospital stays. Various insulin regimens are used in the inpatient diabetes management of non-critically ill patients. We aimed to assess the efficacy and safety of basal-bolus insulin therapy (BBI) by summarizing evidence from studies of BBI versus sliding scale insulin therapy (SSI) in the management of hospitalized non-critically ill type 2 diabetes patients. METHODS: We searched MEDLINE, EMBASE, Scopus and the Cochrane Library for studies comparing BBI therapy with SSI therapy in hospitalized non-critically ill patients with type 2 diabetes...
January 9, 2017: Diabetes/metabolism Research and Reviews
https://www.readbyqxmd.com/read/28042054/design-and-rationale-of-heart-and-lung-failure-pediatric-insulin-titration-trial-half-pint-a-randomized-clinical-trial-of-tight-glycemic-control-in-hyperglycemic-critically-ill-children
#8
Michael Sd Agus, Ellie Hirshberg, Vijay Srinivasan, Edward Vincent Faustino, Peter M Luckett, Martha Aq Curley, Jamin Alexander, Lisa A Asaro, Kerry Coughlin-Wells, Donna Duva, Jaclyn French, Natalie Hasbani, Martha T Sisko, Carmen L Soto-Rivera, Garry Steil, David Wypij, Vinay M Nadkarni
OBJECTIVES: Test whether hyperglycemic critically ill children with cardiovascular and/or respiratory failure experience more ICU-free days when assigned to tight glycemic control with a normoglycemic versus hyperglycemic blood glucose target range. DESIGN: Multi-center randomized clinical trial. SETTING: Pediatric ICUs at 35 academic hospitals. PATIENTS: Children aged 2weeks to 17years receiving inotropic support and/or acute mechanical ventilation, excluding cardiac surgical patients...
February 2017: Contemporary Clinical Trials
https://www.readbyqxmd.com/read/28019037/effect-of-dexamethasone-on-resting-blood-lactate-concentrations-in-horses
#9
K Mizen, J Woodman, S R Boysen, C Wagg, P Greco-Otto, R Léguillette, M-F Roy
BACKGROUND: Blood lactate concentration is a marker of tissue perfusion and helps guide therapeutic interventions in critically ill horses. In both humans and dogs, administration of corticosteroids can increase blood lactate concentration, leading to type B hyperlactatemia. This effect could be a consequence of the impact of corticosteroids on glucose metabolism. OBJECTIVES: To investigate the effects of daily IM dexamethasone administration on blood lactate and glucose concentrations in horses...
January 2017: Journal of Veterinary Internal Medicine
https://www.readbyqxmd.com/read/28004200/hyperinsulinemic-normoglycemia-decreases-glucose-variability-during-cardiac-surgery
#10
Alaa Abd-Elsayed, Edward J Mascha, Dongsheng Yang, Daniel I Sessler, Andra Duncan
PURPOSE: Increased glucose variability may be associated with worse outcomes in critically ill patients. Hyperinsulinemic normoglycemia provides intensive glucose control during surgery and may reduce glucose variability. Our objective was to compare glycemic variability between two methods of glucose control in cardiac surgical patients: hyperinsulinemic normoglycemia vs standard insulin infusion. We also assessed whether the effect differed between patients with and without diabetes mellitus...
December 21, 2016: Journal of Anesthesia
https://www.readbyqxmd.com/read/27998542/-metabolic-control-in-the-critically-ill-patient-an-update-hyperglycemia-glucose-variability-hypoglycemia-and-relative-hypoglycemia
#11
Ángel Augusto Pérez-Calatayud, Ariadna Guillén-Vidaña, Irving Santiago Fraire-Félix, Eduardo Daniel Anica-Malagón, Jesús Carlos Briones Garduño, Raúl Carrillo-Esper
BACKGROUND: Metabolic changes of glucose in critically ill patients increase morbidity and mortality. The appropriate level of blood glucose has not been established so far and should be adjusted for different populations. However concepts such as glucose variability and relative hypoglycemia of critically ill patients are concepts that are changing management methods and achieving closer monitoring. OBJECTIVES: The purpose of this review is to present new data about the management and metabolic control of patients in critical areas...
January 2017: Cirugia y Cirujanos
https://www.readbyqxmd.com/read/27994380/validity-of-bedside-blood-glucose-measurement-in-critically-ill-patients-with-intensive-insulin-therapy
#12
Ata Mahmoodpoor, Hadi Hamishehkar, Kamran Shadvar, Sarvin Sanaie, Afshin Iranpour, Vahid Fattahi
BACKGROUND AND AIMS: There have been variable results on the practice of tight glycemic control, and studies have demonstrated that point-of-care (POC) glucometers have variable accuracy. Glucometers must be accurate, and many variables can affect blood glucose levels. The purpose of this study was to determine the difference between blood glucose concentrations obtained from POC glucometers and laboratory results in critically ill patients with intensive insulin therapy. MATERIALS AND METHODS: This was a descriptive study which enrolled 300 critically ill patients...
November 2016: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/27967228/safety-and-efficacy-of-personalized-glycemic-control-in-critically-ill-patients-a-2-year-before-and-after-interventional-trial
#13
James S Krinsley, Jean-Charles Preiser, Irl B Hirsch
Objective To determine the safety and efficacy of a change in blood glucose (BG) control protocol from a single target to 2 targets based on diabetes status and glycated hemoglobin (A1C) in a cohort of critically ill patients. Methods This investigation includes 1,979 patients admitted to a single intensive care unit between September 16, 2013 and September 15, 2015. The BG target was 90-120 mg/dL in the PRE era and 80-140 mg/dL for patients without diabetes (NON) and diabetes patients (DM) with A1C < 7% and 110-160 mg/dL for DM with A1C > 7% (TIGHT and LOOSE protocols) in the POST era...
December 14, 2016: Endocrine Practice
https://www.readbyqxmd.com/read/27965877/survivors-of-intensive-care-with-type-2-diabetes-and-the-effect-of-shared-care-follow-up-clinics-study-protocol-for-the-sweet-as-randomised-controlled-feasibility-study
#14
Yasmine Ali Abdelhamid, Liza Phillips, Michael Horowitz, Adam Deane
BACKGROUND: Many patients who survive the intensive care unit (ICU) experience long-term complications such as peripheral neuropathy and nephropathy which represent a major source of morbidity and affect quality of life adversely. Similar pathophysiological processes occur frequently in ambulant patients with diabetes mellitus who have never been critically ill. Some 25 % of all adult ICU patients have diabetes, and it is plausible that ICU survivors with co-existing diabetes are at heightened risk of sequelae from their critical illness...
2016: Pilot and Feasibility Studies
https://www.readbyqxmd.com/read/27850087/447-the-impact-of-continuous-glucose-monitoring-systems-on-glucose-control-in-critically-ill-patients
#15
Meizhu Lu, Yan Kang, Jun Guo
No abstract text is available yet for this article.
December 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27821581/association-between-the-use-of-long-acting-insulin-and-hypoglycemia-in-nondiabetic-patients-in-the-surgical-intensive-care-unit
#16
Jordan Masse, Christopher Alan Giuliano, Sara Brown, Renee Alexander Paxton
PURPOSE: The purpose of this study was to examine the association between long-acting insulin and hypoglycemia in nondiabetic surgical intensive care patients. METHODS: This single-center, retrospective cohort study evaluated glycemic control in nondiabetic critically ill surgical patients receiving long-acting insulin plus sliding scale versus those receiving sliding scale alone. Patients were matched based on sliding scale order and type of surgery. The primary outcome was the proportion of patients who experienced hypoglycemia (glucose values <70 mg/dL)...
November 7, 2016: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/27802272/isoflurane-and-sevoflurane-induce-severe-hepatic-insulin-resistance-in-a-canine-model
#17
Stella P Kim, Josiane L Broussard, Cathryn M Kolka
INTRODUCTION: Anesthesia induces insulin resistance, which may contribute to elevated blood glucose and adverse post-operative outcomes in critically ill patients, and impair glycemic control in surgical patients with diabetes. However, little is known about the mechanisms by which anesthesia impairs insulin sensitivity. Here we investigate the effects of anesthesia on insulin sensitivity in metabolic tissues. METHODS: Hyperinsulinemic-euglycemic clamps were performed in 32 lean (control diet; n = 16 conscious versus n = 16 anesthetized) and 24 fat-fed (6 weeks fat-feeding; n = 16 conscious versus n = 8 anesthetized) adult male mongrel dogs in conjunction with tracer methodology to differentiate hepatic versus peripheral insulin sensitivity...
2016: PloS One
https://www.readbyqxmd.com/read/27761451/glucose-management-in-the-intensive-care-unit-are-we-looking-for-the-right-sweet-spot
#18
COMMENT
Sarah J Beesley, Eliotte L Hirshberg, Michael J Lanspa
In a recently published issue of Critical Care Medicine, Kar and colleagues investigated glucose management of critically ill patients with type 2 diabetes. In this commentary, we discuss the challenges of investigating glucose control in the critically ill, why so many internally valid studies in this field lead to conflicting results, and the obstacles preventing investigators from reaching a conclusive answer.
September 2016: Annals of Translational Medicine
https://www.readbyqxmd.com/read/27757740/design-and-%C3%AE-testing-of-an-electronic-rounding-tool-certainp-to-improve-process-of-care-in-pediatric-intensive-care-unit
#19
Manasi Hulyalkar, Stephen J Gleich, Rahul Kashyap, Amelia Barwise, Harsheen Kaur, Yue Dong, Lei Fan, Srinivas Murthy, Grace M Arteaga, Sandeep Tripathi
Increasing process complexity in the pediatric intensive care unit (PICU) can lead to information overload resulting in missing pertinent information and potential errors during morning rounds. An efficient model using a novel electronic rounding tool was designed as part of a broader critical care decision support system-checklist for early recognition and treatment of acute illness and injury in pediatrics (CERTAINp). We aimed to evaluate its impact on improving the process of care during rounding. Prospective pre- and post-interventional data included: team performance baseline assessment, patient safety discussion, guideline adherence, rounding time, and a survey of Residents' and Nurses' perception using a Likert scale...
October 18, 2016: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/27749341/association-between-perioperative-hyperglycemia-or-glucose-variability-and-postoperative-acute-kidney-injury-after-liver-transplantation-a-retrospective-observational-study
#20
Seokha Yoo, Ho-Jin Lee, Hannah Lee, Ho-Geol Ryu
BACKGROUND: Glucose control can be difficult in the intraoperative and immediate postoperative period of liver transplantation. Hyperglycemia and glucose variability have been associated with acute kidney injury (AKI) in critically ill patients. We performed a retrospective study to test the hypothesis that perioperative glucose levels represented by time-weighted average glucose levels and glucose variability are independently associated with the incidence of postoperative AKI in patients undergoing liver transplantation...
January 2017: Anesthesia and Analgesia
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