Intensive insulin therapy: enhanced Model Predictive Control algorithm versus standard care
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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.
Patients and participants
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.
Measurements and results
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.
KeywordsHyperglycaemia Glucose Critical care Insulin Model Predictive Control Algorithm
The authors wish to thank the patients, nurses, doctors, clinical engineers and allied health professionals in both ICUs for their support in undertaking this study. The CLINICIP project is supported by an EC 6th Framework Programme grant.
- 6.Pittas AG, Siegel RD, Lau J (2006) Insulin therapy and in-hospital mortality in critically ill patients: systematic review and meta-analysis of randomized controlled trials. JPEN 30:164–172Google Scholar
- 8.CLINICIP. Available online at: http://www.clinicip.org. Accessed 12 March 2007
- 9.Plank J, Blaha J, Cordingley J, Wilinska ME, Chassin LJ, Morgan C, Squire S, Haluzik M, Svacina S, Toller W, Plasnik A, Ellmerer M, Hovorka R, Pieber TR (2006) Multicentric, randomized, controlled trial to evaluate blood glucose control by the model predictive control algorithm versus routine glucose management protocols in intensive care unit patients. Diabetes Care 29:271–276PubMedCrossRefGoogle Scholar
- 10.Cordingley J, Vlaselaers D, Hovorka R, Dormand N, Wouters P, Chassin L, Squire S, Wilinska M, Morgan C, Van den Berghe G (2007) Tight glycaemic control in critically ill patients: two centre trial of enhanced model predictive algorithm versus standard care. Intensive Care Med 33(Suppl 2):190Google Scholar