Aortic dP/dt_max accurately reflects left ventricular contractility when effective preload independence is achieved

in Critical Care: the Official Journal of the Critical Care Forum (2010), 14 (Suppl 1)

Model-based cardiac disease diagnosis in critical care

in Proceedings of the Health Research Society of Canterbury (HRSC) Clinical Meeting 2010 (2010)

Estimating the driver function of a cardiovascular system model

in Proceedings of CONTROL 2010 (2010)

Assessment of ventricular-arterial coupling with a model-based sensor

in Proceedings of CONTROL 2010 (2010)

NAVA enhances ventilatory variability and diaphragmatic activity/tidal volume coupling

in Intensive Care Medicine (2010), 36 (Suppl 2)

The future of glycaemic control in critically ill patients requires a close collaboration between bio-engineers and clinicians

in Proceedings of CONTROL 2010 (2010)

Validation of a virtual trial method for tight glycemic control in intensive care

in Proceedings of the Health Research Society of Canterbury (HRSC) Clinical Meeting 2010 (2010)

Reduced Organ Failure with Effective Glycemic Control

in Intensive Care Medicine (2010), 36 (Suppl 2)

Validation of a Model-based Virtual Trials Method for Tight Glycaemic Control in Intensive Care

in Proceedings of the Centre for Bio-Engineering One Day Conference 2010 (2010)

Organ failure and tight glycemic control in the SPRINT study.

in Critical Care: the Official Journal of the Critical Care Forum (2010), 14(4), 154

INTRODUCTION: Intensive care unit mortality is strongly associated with organ failure rate and severity. The sequential organ failure assessment (SOFA) score is used to evaluate the impact of a successful ... [more ▼]

INTRODUCTION: Intensive care unit mortality is strongly associated with organ failure rate and severity. The sequential organ failure assessment (SOFA) score is used to evaluate the impact of a successful tight glycemic control (TGC) intervention (SPRINT) on organ failure, morbidity, and thus mortality. METHODS: A retrospective analysis of 371 patients (3,356 days) on SPRINT (August 2005 - April 2007) and 413 retrospective patients (3,211 days) from two years prior, matched by Acute Physiology and Chronic Health Evaluation (APACHE) III. SOFA is calculated daily for each patient. The effect of the SPRINT TGC intervention is assessed by comparing the percentage of patients with SOFA </=5 each day and its trends over time and cohort/group. Organ-failure free days (all SOFA components </=2) and number of organ failures (SOFA components >2) are also compared. Cumulative time in 4.0 to 7.0 mmol/L band (cTIB) was evaluated daily to link tightness and consistency of TGC (cTIB >/=0.5) to SOFA </=5 using conditional and joint probabilities. RESULTS: Admission and maximum SOFA scores were similar (P = 0.20; P = 0.76), with similar time to maximum (median: one day; IQR: 13 days; P = 0.99). Median length of stay was similar (4.1 days SPRINT and 3.8 days Pre-SPRINT; P = 0.94). The percentage of patients with SOFA </=5 is different over the first 14 days (P = 0.016), rising to approximately 75% for Pre-SPRINT and approximately 85% for SPRINT, with clear separation after two days. Organ-failure-free days were different (SPRINT = 41.6%; Pre-SPRINT = 36.5%; P < 0.0001) as were the percent of total possible organ failures (SPRINT = 16.0%; Pre-SPRINT = 19.0%; P < 0.0001). By Day 3 over 90% of SPRINT patients had cTIB >/=0.5 (37% Pre-SPRINT) reaching 100% by Day 7 (50% Pre-SPRINT). Conditional and joint probabilities indicate tighter, more consistent TGC under SPRINT (cTIB >/=0.5) increased the likelihood SOFA </=5. CONCLUSIONS: SPRINT TGC resolved organ failure faster, and for more patients, from similar admission and maximum SOFA scores, than conventional control. These reductions mirror the reduced mortality with SPRINT. The cTIB >/=0.5 metric provides a first benchmark linking TGC quality to organ failure. These results support other physiological and clinical results indicating the role tight, consistent TGC can play in reducing organ failure, morbidity and mortality, and should be validated on data from randomised trials. [less ▲]