scholarly journals Determination of favorable blood glucose target range for stochastic TARgeted (STAR) glycemic control in Malaysia

2019 ◽  
Vol 15 (1) ◽  
pp. 133
Author(s):  
A. Abu-Samah ◽  
N. N. A. Razak ◽  
A. A. Razak ◽  
U. K. Jamaludin ◽  
F. M. Suhaimi ◽  
...  
Keyword(s):  
Intensive Care ◽  
Blood Glucose ◽  
Glycemic Control ◽  
Intensive Care Units ◽  
Target Range ◽  
Nursing Interventions ◽  
Method Performance ◽  
Scale Method ◽  
Sliding Scale

Stress-induced hyperglycemia is common in critically ill patients, but there is uncertainty about what constitutes an optimal blood glucose target range for glycemic control. Furthermore, to reduce the rate of hyperglycemic and hypoglycemic events, model-based glycemic control protocols have been introduced, such as the stochastic targeted (STAR) glycemic control protocol. This protocol has been used in the intensive care units of Christchurch and Gyulà Hospital since 2010, and in Malaysia since 2017. In this study, we analyzed the adaptability of the protocol and identified the blood glucose target range most favorable for use in the Malaysian population. Virtual simulation results are presented for two clinical cohorts: one receiving treatment by the STAR protocol itself and the other receiving intensive insulin therapy by the sliding scale method. Performance and safety were analyzed using five clinical target ranges, and best control was simulated at a target range of 6.0–10.0 mmol/L. This target range had the best balance of performance, with the lowest risk of hypoglycemia and the lowest requirement for nursing interventions. The result is encouraging as the STAR protocol is suitable to provide better and safer glycemic control while using a target range that is already widely used in Malaysian intensive care units

An Efficiency Evaluation of Protocols for Tight Glycemic Control in Intensive Care Units

2007 ◽  
Vol 16 (6) ◽  
pp. 589-598 ◽  
Author(s):  
Mark A. Malesker ◽  
Pamela A. Foral ◽  
Ann C. McPhillips ◽  
Keith J. Christensen ◽  
Julie A. Chang ◽  
...  
Keyword(s):  
Intensive Care ◽  
Blood Glucose ◽  
Glycemic Control ◽  
Intensive Care Units ◽  
Tight Glycemic Control ◽  
Third Party ◽  
Full Time ◽  
Motion Data ◽  
Time Motion ◽  
The Impact

Background The efficiency of protocols for tight glycemic control is uncertain despite their adoption in hospitals. Objectives To evaluate the efficiency of protocols for tight glycemic control used in intensive care units. Methods Three separate studies were performed: (1) a third-party observer used a stopwatch to do a time-motion analysis of patients being treated with a protocol for tight glycemic control in 3 intensive care units, (2) charts were retrospectively reviewed to determine the frequency of deviations from the protocol, and (3) a survey assessing satisfaction with and knowledge of the protocol was administered to full-time nurses. Results Time-motion data were collected for 454 blood glucose determinations from 38 patients cared for by 47 nurses. Mean elapsed times from blood glucose result to therapeutic action were 2.24 (SD, 1.67) minutes for hypoglycemia and 10.65 (SD, 3.24) minutes for hyperglycemia. Mean elapsed time to initiate an insulin infusion was 32.56 (SD, 12.83) minutes. Chart review revealed 734 deviations from the protocol in 75 patients; 57% (n = 418) were deviations from scheduled times for blood glucose measurements. The mean number of deviations was approximately 9 per patient. Of 60 nurses who responded to the workload survey, 42 (70%) indicated that the protocol increased their workload; frequency of blood glucose determinations was the most common reason. Conclusions Nurses spend substantial time administering protocols for tight glycemic control, and considerable numbers of deviations occur during that process. Further educational efforts and ongoing assessment of the impact of such protocols are needed.

scholarly journals Development process of multiagent system for glycemic control of intensive care unit patients

2021 ◽  
Vol 10 (1) ◽  
pp. 43
Author(s):  
Tiago Henrique Faccio Segato ◽  
Célia Ghedini Ralha ◽  
Sérgio Eduardo Soares Fernandes
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Glucose ◽  
Glycemic Control ◽  
Care Physician ◽  
Target Range ◽  
Production Rules ◽  
Inference Mechanism ◽  
Agent Based ◽  
Intuitionistic Fuzzy Logic

This article presents the entire process of developing an agent-based system for the glycemic control of patients in the Intensive Care Unit (ICU). The agent’s goal is to monitor and recommend treatment to keep the patient’s blood glucose within the target range, avoiding complications in the health of patients and even decreasing rates of morbidity and mortality in the ICU. The process of developing the agent-based solution was presented, starting from the understanding of the problem, including a brief review of the literature, going through the pre-project and modelling through the Tropos methodology, until the implementation. The agent inference mechanism is based on production rules and intuitionistic fuzzy logic. An illustration of use, with the collaboration of a specialist intensive care physician, shows how agents behave in a real situation of monitoring and controlling the blood glucose of patients admitted to the ICU, interacting with all elements of the proposed architecture. Finally, feedback from health professionals indicate the system can assist in the glycemic control of patients in the ICU having advantages over traditional monitoring systems.

scholarly journals Practice of Hyperglycaemia Control in Intensive Care Units of the Military Hospital, Sudan - Needs of a Protocol

2020 ◽  
Author(s):  
Ghada O Abd El-Raheem
Keyword(s):  
Intensive Care ◽  
Blood Glucose ◽  
Intensive Care Units ◽  
Military Hospital ◽  
Diabetic Patients ◽  
Control Methods ◽  
Healthcare Staff ◽  
Glycaemia Control ◽  
Sliding Scale ◽  
The Military

Hyperglycaemia is a major risk factor in critically ill patients as it leads to adverse outcomes and mortality in diabetic and non-diabetic patients. The target blood glucose remained controversial; this study aimed to contribute in assessing the practice of hyperglycaemia control in intensive care units of Khartoum Military Hospital. Furthermore, it proposed a protocol for hyperglycaemia control based on findings. A hospital-based cross-sectional study assessed the awareness and practice towards hyperglycaemia management in a sample of 83 healthcare staff selected through stratified random sampling technique. In addition, 55 patients were enrolled, through quota sampling, after excluding those with diabetic ketoacidosis, hyperosmolar-hyperglycaemic state and patients < 18 years. A self-administrated questionnaire enabled to collect data from healthcare staff, patients data were extracted from medical records. SPSS 23 was used to analyse the collected data. Chi-square and ANOVA tests assessed the association among variables. All statistical tests were considered statistically significant when p < 0.05. The training on hyperglycaemia control differed statistically (p= 0.017) among healthcare staff. The target glycaemic level (140-180 mg/dl) was knew by 11.1% of the study participants. Neither the knowledge nor the practice of hyperglycaemia control methods differed among staff (p> 0.05). The use of sliding scale was 79.3% across the ICUs with a statistically significant difference (p= 0.002). 31.5% of patients had received glycaemic control based on different methods and 11.8% were in the targeted blood glucose level. Sliding scale was the prevalent method used by doctors (71.4%) and nurses (81.6%). A patient benefited from insulin infusion method, which achieved the NICE-SUGAR target. The poor knowledge and lack of awareness towards hyperglycaemia monitoring led to inappropriate implementation of glycaemia control methods across the Military Hospital ICUs. Sustained training programs on hyperglycaemia control to ICU staff and the availability of a protocol on glycaemia control are highly required.

How Low Should You Go? The Limbo of Glycemic Control in Intensive Care Units

2011 ◽  
Vol 31 (4) ◽  
pp. e9-e18 ◽  
Author(s):  
A. C. Faust ◽  
R. L. Attridge ◽  
L. Ryan
Keyword(s):  
Intensive Care ◽  
Glycemic Control ◽  
Intensive Care Units

scholarly journals Proposing an Empirically Justified Reference Threshold for Blood Culture Sampling Rates in Intensive Care Units

2014 ◽  
Vol 53 (2) ◽  
pp. 648-652 ◽  
Author(s):  
André Karch ◽  
Stefanie Castell ◽  
Frank Schwab ◽  
Christine Geffers ◽  
Hannah Bongartz ◽  
...  
Keyword(s):  
Intensive Care ◽  
Blood Culture ◽  
Intensive Care Units ◽  
Poisson Regression ◽  
Bloodstream Infections ◽  
Standard Of Care ◽  
Target Range ◽  
Locally Weighted Regression ◽  
Infection Surveillance ◽  
Reference Threshold

Early and appropriate blood culture sampling is recommended as a standard of care for patients with suspected bloodstream infections (BSI) but is rarely taken into account when quality indicators for BSI are evaluated. To date, sampling of about 100 to 200 blood culture sets per 1,000 patient-days is recommended as the target range for blood culture rates. However, the empirical basis of this recommendation is not clear. The aim of the current study was to analyze the association between blood culture rates and observed BSI rates and to derive a reference threshold for blood culture rates in intensive care units (ICUs). This study is based on data from 223 ICUs taking part in the German hospital infection surveillance system. We applied locally weighted regression and segmented Poisson regression to assess the association between blood culture rates and BSI rates. Below 80 to 90 blood culture sets per 1,000 patient-days, observed BSI rates increased with increasing blood culture rates, while there was no further increase above this threshold. Segmented Poisson regression located the threshold at 87 (95% confidence interval, 54 to 120) blood culture sets per 1,000 patient-days. Only one-third of the investigated ICUs displayed blood culture rates above this threshold. We provided empirical justification for a blood culture target threshold in ICUs. In the majority of the studied ICUs, blood culture sampling rates were below this threshold. This suggests that a substantial fraction of BSI cases might remain undetected; reporting observed BSI rates as a quality indicator without sufficiently high blood culture rates might be misleading.

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