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Báo cáo y học: "Hourly measurements not required for safe and effective glycemic control in the critically ill patient"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Hourly measurements not required for safe and effective glycemic control in the critically ill patient. | Hoekstra et al. Critical Care 2010 14 404 http ccforum.eom content 14 1 404 CRITICAL CARE LETTER L_ Hourly measurements not required for safe and effective glycemic control in the critically ill patient Miriam Hoekstra 1 Mathijs Vogelzang2 Evgeny Verbitskiy3 4 and Maarten W Nijsten5 In the recently published work of Juneja and colleagues the authors describe the excellent results of a computerized insulin dosing algorithm Clarian GlucoStabilizer 1 . To prevent hypoglycemia however the authors note that frequent that is hourly measurements are required. We believe that with an adequate algorithm the required level of glucose control can be reached without hourly glucose measurements. We implemented the glucose regulation for intensive care patients GRIP computer-assisted glucose regulation program which uses time-variant sampling intervals 2 . In a recent analysis hypoglycemia rates were comparable with or lower than those described by Juneja and colleagues 3 . Most importantly these rates were achieved with only 5.6 measurements per patient per day. In all fairness it must be said that GRIP aimed at and achieved levels of 4.0 to 7.5 mmol l which is not as tight and challenging as the GlucoStabilizer target of 4.4 to 6.1 mmol l. Nevertheless it is our conviction that an up to fivefold higher glucose sampling rate cannot be justified by current evidence on glucose control. Finally we would like to note that two main approaches for designing computer control of glucose levels exist model predictive control and proportional-integral derivative 4 . The underlying algorithm of GRIP is not model predictive control as mistakenly stated in the article by Juneja and colleagues 1 but proportional-integral derivative. In fact the algorithm of Juneja and colleagues also appears to be proportional-integral derivative. To achieve effective and safe computerized glucose control therefore it is not necessary to perform hourly measurements provided a realistic target and an .