Dataset Information

Glucose control in intensive care: usability, efficacy and safety of Space GlucoseControl in two medical European intensive care units.

ABSTRACT: BACKGROUND:The Space GlucoseControl system (SGC) is a nurse-driven, computer-assisted device for glycemic control combining infusion pumps with the enhanced Model Predictive Control algorithm (B. Braun, Melsungen, Germany). We aimed to investigate the performance of the SGC in medical critically ill patients. METHODS:Two open clinical investigations in tertiary centers in Graz, Austria and Zurich, Switzerland were performed. Efficacy was assessed by percentage of time within the target range (4.4-8.3 mmol/L; primary end point), mean blood glucose, and sampling interval. Safety was assessed by the number of hypoglycemic episodes (?2.2 mmol/L) and the percentage of time spent below this cutoff level. Usability was analyzed with a standardized questionnaire given to involved nursing staff after the trial. RESULTS:Forty medical critically ill patients (age, 62?±?15 years; body mass index, 30.0?±?8.9 kg/m2; APACHE II score, 24.8?±?5.4; 27 males; 8 with diabetes) were included for a period of 6.5?±?3.7 days (n?=?20 in each center). The primary endpoint (time in target range 4.4 to 8.3 mmol/l) was reached in 88.3%?±?9.3 of the time and mean arterial blood glucose was 6.7?±?0.4 mmol/l. The sampling interval was 2.2?±?0.4 hours. The mean daily insulin dose was 87.2?±?64.6 IU. The adherence to the given insulin dose advice was high (98.2%). While the percentage of time spent in a moderately hypoglycemic range (2.2 to 3.3 mmol/L) was low (0.07?±?0.26% of the time), one severe hypoglycemic episode (<2.2 mmol/L) occurred (2.5% of patients or 0.03% of glucose readings). CONCLUSIONS:SGC is a safe and efficient method to control blood glucose in critically ill patients as assessed in two European medical intensive care units.

SUBMITTER: Amrein K

PROVIDER: S-EPMC4118658 | biostudies-literature | 2014 Jul

REPOSITORIES: biostudies-literature

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Glucose control in intensive care: usability, efficacy and safety of Space GlucoseControl in two medical European intensive care units.

Amrein Karin K Kachel Norman N Fries Heike H Hovorka Roman R Pieber Thomas R TR Plank Johannes J Wenger Urs U Lienhardt Barbara B Maggiorini Marco M

BMC endocrine disorders 20140729

<h4>Background</h4>The Space GlucoseControl system (SGC) is a nurse-driven, computer-assisted device for glycemic control combining infusion pumps with the enhanced Model Predictive Control algorithm (B. Braun, Melsungen, Germany). We aimed to investigate the performance of the SGC in medical critically ill patients.<h4>Methods</h4>Two open clinical investigations in tertiary centers in Graz, Austria and Zurich, Switzerland were performed. Efficacy was assessed by percentage of time within the t ...[more]

PMID: 25074071

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Project description:BackgroundAlthough the weaning classification based on the difficulty and duration of the weaning process has been evaluated in the different type of intensive care units (ICUs), little is known about clinical outcomes and validity among the three groups in medical ICU. The objectives of this study were to evaluate the clinical relevance of weaning classification and its association with hospital mortality in a medical ICU with a protocol-based weaning program.MethodsAll consecutive patients admitted to the medical ICU and requiring mechanical ventilation (MV) for more than 24 hours were prospectively registered and screened for weaning readiness by a standardized weaning program between July 2010 and June 2013. Baseline characteristics and outcomes were compared across weaning classifications.ResultsDuring the study period, a total of 680 patients were weaned according to the standardized weaning protocol. Of these, 457 (67%) were classified as simple weaning, 136 (20%) as difficult weaning, and 87 (13%) as prolonged weaning. Ventilator-free days within 28 days decreased significantly from simple to difficult to prolonged weaning groups (P < 0.001, test for trends). In addition, reintubation within 48 hours after extubation (P < 0.001) and need for tracheostomy during the weaning process (P < 0.001) increased significantly across weaning groups. Finally, ICU (P < 0.001), post-ICU (P = 0.001), and hospital (P < 0.001) mortalities significantly increased across weaning groups. In a multiple logistic regression model, prolonged weaning but not difficult weaning was still independently associated with ICU (adjusted OR 8.265, 95% CI 3.484-19.605, P < 0.001), and post-ICU (adjusted OR 3.180, 95% CI 1.349-7.497, P = 0.005), and hospital (adjusted OR 5.528, 95% CI 2.801-10.910, P < 0.001) mortalities.ConclusionsWeaning classification based on the difficulty and duration of the weaning process may provide prognostic information for mechanically ventilated patients who undergo the weaning process.

Project description:ImportanceEnd-of-life decisions occur daily in intensive care units (ICUs) around the world, and these practices could change over time.ObjectiveTo determine the changes in end-of-life practices in European ICUs after 16 years.Design, setting, and participantsEthicus-2 was a prospective observational study of 22 European ICUs previously included in the Ethicus-1 study (1999-2000). During a self-selected continuous 6-month period at each ICU, consecutive patients who died or had any limitation of life-sustaining therapy from September 2015 until October 2016 were included. Patients were followed up until death or until 2 months after the first treatment limitation decision.ExposuresComparison between the 1999-2000 cohort vs 2015-2016 cohort.Main outcomes and measuresEnd-of-life outcomes were classified into 5 mutually exclusive categories (withholding of life-prolonging therapy, withdrawing of life-prolonging therapy, active shortening of the dying process, failed cardiopulmonary resuscitation [CPR], brain death). The primary outcome was whether patients received any treatment limitations (withholding or withdrawing of life-prolonging therapy or shortening of the dying process). Outcomes were determined by senior intensivists.ResultsOf 13?625 patients admitted to participating ICUs during the 2015-2016 study period, 1785 (13.1%) died or had limitations of life-prolonging therapies and were included in the study. Compared with the patients included in the 1999-2000 cohort (n?=?2807), the patients in 2015-2016 cohort were significantly older (median age, 70 years [interquartile range {IQR}, 59-79] vs 67 years [IQR, 54-75]; P?<?.001) and the proportion of female patients was similar (39.6% vs 38.7%; P?=?.58). Significantly more treatment limitations occurred in the 2015-2016 cohort compared with the 1999-2000 cohort (1601 [89.7%] vs 1918 [68.3%]; difference, 21.4% [95% CI, 19.2% to 23.6%]; P?<?.001), with more withholding of life-prolonging therapy (892 [50.0%] vs 1143 [40.7%]; difference, 9.3% [95% CI, 6.4% to 12.3%]; P?<?.001), more withdrawing of life-prolonging therapy (692 [38.8%] vs 695 [24.8%]; difference, 14.0% [95% CI, 11.2% to 16.8%]; P?<?.001), less failed CPR (110 [6.2%] vs 628 [22.4%]; difference, -16.2% [95% CI, -18.1% to -14.3%]; P?<?.001), less brain death (74 [4.1%] vs 261 [9.3%]; difference, -5.2% [95% CI, -6.6% to -3.8%]; P?<?.001) and less active shortening of the dying process (17 [1.0%] vs 80 [2.9%]; difference, -1.9% [95% CI, -2.7% to -1.1%]; P?<?.001).Conclusions and relevanceAmong patients who had treatment limitations or died in 22 European ICUs in 2015-2016, compared with data reported from the same ICUs in 1999-2000, limitations in life-prolonging therapies occurred significantly more frequently and death without limitations in life-prolonging therapies occurred significantly less frequently. These findings suggest a shift in end-of-life practices in European ICUs, but the study is limited in that it excluded patients who survived ICU hospitalization without treatment limitations.

Dataset Information

Glucose control in intensive care: usability, efficacy and safety of Space GlucoseControl in two medical European intensive care units.

Publications

Glucose control in intensive care: usability, efficacy and safety of Space GlucoseControl in two medical European intensive care units.

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