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.
OBJECTIVE
To evaluate a fully automated algorithm for the establishment of tight glycemic control in critically ill patients and to compare the results with different routine glucose management protocols of three intensive care units (ICUs) across Europe (Graz, Prague, and London).


METHODS
Sixty patients undergoing cardiac surgery (age 67 +/- 9 years, BMI 27.7 +/- 4.9 kg/m2, 17 women) with postsurgery blood glucose levels >120 mg/dl (6.7 mmol/l) were investigated in three different ICUs (20 per center). Patients were randomized to either blood glucose management (target range 80-110 mg/dl [4.4-6.1 mmol/l]) by the fully automated model predictive control (MPC) algorithm (n = 30, 10 per center) or implemented routine glucose management protocols (n = 30, 10 per center). In all patients, arterial glucose was measured hourly to describe the glucose profile until the end of the ICU stay but for a maximum period of 48 h.


RESULTS
Compared with routine protocols, MPC treatment resulted in a significantly higher percentage of time within the target glycemic range (% median [min-max]: 52 [17-92] vs. 19 [0-71]) over 0-24 h (P < 0.01). Improved glycemic control with MPC treatment was confirmed in patients remaining in the ICU for 48 h (0-24 h: 50 [17-71] vs. 21 [4-67], P < 0.05, and 24-48 h: 65 [38-96] vs. 25 [8-79], P < 0.05, for MPC [n = 16] vs. routine protocol [n = 13], respectively). Two hypoglycemic events (<54 mg/dl [3.0 mmol/l]) were observed with routine protocol treatment. No hypoglycemic event occurred with MPC.


CONCLUSIONS
The data suggest that the MPC algorithm is safe and effective in controlling glycemia in critically ill postsurgery patients.
Plank
Johannes
J
Department of Internal Medicine, Medical University Hospital, Graz, Auenbruggerplatz 15, 8036 Graz, Austria. johannes.plank@klinikum-graz.at
Blaha
Jan
J
Cordingley
Jeremy
J
Wilinska
Malgorzata E
ME
Chassin
Ludovic J
LJ
Morgan
Cliff
C
Squire
Stephen
S
Haluzik
Martin
M
Kremen
Jaromir
J
Svacina
Stepan
S
Toller
Wolfgang
W
Plasnik
Andreas
A
Ellmerer
Martin
M
Hovorka
Roman
R
Pieber
Thomas R
TR
D000368:Aged; D000465:Algorithms; D001786:Blood Glucose / Q000378:metabolism*; D002241:Carbohydrates / Q000008:administration & dosage; D016638:Critical Illness; D005260:Female; D006331:Heart Diseases / Q000097:blood / Q000601:surgery*; D006801:Humans; D007003:Hypoglycemia / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use; D007362:Intensive Care Units; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods*; D011182:Postoperative Care
D001786:Blood Glucose; D002241:Carbohydrates; D007004:Hypoglycemic Agents; D007328:Insulin