Authors: Chase, J. G.; Shaw, Geoffrey M.; Lotz, Thomas; LeCompte, Aaron; Wong, Jason; Lin, Jessica; Lonergan, Timothy; Willacy, Michael; Hann, Christopher E.

Source: Current Drug Delivery, Volume 4, Number 4, October 2007 , pp. 283-296(14)

Publisher: Bentham Science Publishers

Abstract:

Objective: Present a new model-based tight glycaemic control approach using variable insulin and nutrition administration.

Background: Hyperglycaemia is prevalent in critical care. Current published protocols use insulin alone to reduce blood glucose levels, require significant added clinical effort, and provide highly variable results. None directly address both the practical clinical difficulties and significant patient variation seen in general critical care, while also providing tight control.

Methods: The approach presented manages both nutritional inputs and exogenous insulin infusions using tables simplified from a modelbased, computerised protocol. Unique delivery aspects include bolus insulin delivery for safety and variable enteral nutrition rates. Unique development aspects include the use of simulated virtual patient trials created from retrospective data. The model, protocol development, and first 50 clinical case results are presented.

Results: High qualitative correlation to within +/-10% between simulated virtual trials and published clinical results validates the overall approach. Pilot tests covering 7358 patient hours produced an average glucose of 5.9 +/- 1.1 mmol/L. Time in the 4-6.1 mmol/L band was 59%, with 84% in 4.0-7.0 mmol/L, and 92% in 4.0-7.75 mmol/L. The average feed rate was 63% of patient specific goal feed and the average insulin dose was 2.6U/hour. There was one hypoglycaemic measurement of 2.1 mmol/L. No departures from protocol or clinical interventions were required at any time.

Summary: Modulating both low dose insulin boluses and nutrition input rates challenges the current practice of using only insulin in larger doses to reduce hyperglycaemic levels. Clinical results show very tight control in safe glycaemic bands. The approach could be readily adopted in any typical ICU.

Keywords: hyperglycaemia; SPRINT Protocol; APACHE II score; Virtual Trial; blood glucose

Document Type: Research article

Publication date: 2007-10-01

More about this publication?

• The aim of Current Drug Delivery is to publish peer-reviewed articles, short communications, short and in-depth reviews in the rapidly developing field of drug delivery. Modern drug research aims to build in delivery properties of a drug at the design phase, however in many cases this ideal cannot be met and the development of delivery systems becomes as important as the development as the drugs themselves.
  
  The journal aims to cover the latest outstanding developments in drug and vaccine delivery employing physical, physico-chemical and chemical methods. The drugs include a wide range of bioactive compounds from simple pharmaceuticals to peptides, proteins, nucleotides, nucleosides and sugars. The journal will also report progress in the fields of transport routes and mechanisms including efflux proteins and multi-drug resistance.
  
  The journal is essential for all pharmaceutical scientists involved in drug design, development and delivery.

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• By this author: Chase, J. G. ;  Shaw, Geoffrey M. ;  Lotz, Thomas ;  LeCompte, Aaron ;  Wong, Jason ;  Lin, Jessica ;  Lonergan, Timothy ;  Willacy, Michael ;  Hann, Christopher E.

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