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Vol. 47, No. 1, 2011
Issue release date: June 2011

Preliminary Study on Glucose Control with an Artificial Pancreas in Postoperative Sepsis Patients

Takahashi G. · Sato N. · Matsumoto N. · Shozushima T. · Hoshikawa K. · Akitomi S. · Kikkawa T. · Onodera C. · Kojika M. · Inoue Y. · Suzuki K. · Wakabayashi G. · Endo S.
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Abstract

Background: Glucose control is essential to avoid hypoglycemia in postoperative patients. Aim: To conduct a preliminary examination to evaluate the feasibility of the use of an artificial pancreas for glucose control as well as the accuracy of assessment by the artificial pancreas of the insulin dose required. Subjects and Methods: Glucose control using an artificial pancreas was undertaken in 8 postoperative sepsis patients. The blood glucose level was set at 80–150 mg/dl. Blood glucose levels over time, insulin dose requirements, and occurrence of hypoglycemia (≤40 mg/dl) were recorded for each patient. The patients were divided into 2 groups based on the total insulin dose they received over the 7 days (HG, n = 4: consisting of patients who required a higher insulin dose; LG, n = 4: patients who required a lower insulin dose). The data of the 2 groups were analyzed retrospectively. Results: The blood glucose level before glucose control was 203.3 ± 9.9 mg/dl and could be controlled in all patients to within the target range. No hypoglycemia events were recorded for any of the patients. The insulin dose in the HG and LG groups was 21,824.8 ± 6,030.4 and 6,254.5 ± 3,402.3 mU/kg (p < 0.05). Conclusions: Accurate glucose control could be achieved with the artificial pancreas.



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References

  1. Van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P, Bouillon R: Intensive insulin therapy in critically ill patients. N Engl J Med2001;345:1359–1367.
  2. Dellinger RP, Carlet JM, Masur H, Gerlach H, Calandra T, Cohen J, Gea-Banacloche J, Keh D, Marshall JC, Parker MM, Ramsay G, Zimmerman JL, Vincent JL, Levy MM: Surviving sepsis campaign guidelines for management of severe sepsis and septic shock. Crit Care Med 2004;32:858–872.
  3. Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, Reinhart K, Angus DC, Brun-Buission C, Beale R, Calandra T, Dhainaut JF, Gerlach H, Harvey M, Marini JJ, Marshall J, Ranieri M, Ramsay G, Sevransky J, Thompson BT, Townsend S, Vender JS, Zimmerman JL, Vincent JL: Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med 2008;36:296–327.
  4. NICE-SUGAR Study Investigators, Finfer S, Chittock DR, Su SY, Blair D, Foster D, et al: Intensive versus conventional glucose control in critically ill patients. N Engl J Med 2009;360:1283–1297.
  5. Kono T, Hanazaki K, Yazawa K, Ashizawa S, Fisher WE, Wang XP, Nose Y, Brunicardi FC, Debakey ME: Pancreatic polypeptide administration reduces insulin requirements of artificial pancreas in pancreatectomized dogs. Artif Organs 2005;29:83–87.
  6. Okabayashi T, Hanazaki K, Nishimori I, Sugimoto T, Maeda H, Yatabe T, Dabanaka K, Kobayashi M, Yamashita K: Continuous post-operative blood glucose monitoring and control using a closed-loop system in patients undergoing hepatic resection. Dig Dis Sci 2008;53:1405–1410.
  7. Knaus WA, Draper EA, Wagner DP, Zimmerman JE: APACHE II: a severity of disease classification system. Crit Care Med1985;13:818–829.
  8. Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, Reinhart CK, Suter PM, Thijs LG: The SOFA (sepsis-related organ failure assessment) score to describe organ dysfunction/failure. On behalf of the working group on sepsis-related problems of the European society of intensive care medicine. Intensive Care Med1996;22:707–710.
  9. The American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference Committee: Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Chest 1992;101:1644–1655.
  10. The ARDS Network: Ketoconazole for early treatment of acute lung injury and acute respiratory distress syndrome: a randomized controlled trial. JAMA 2000;283:1995–2002.
  11. Krinsley JS: Effect of an intensive glucose management protocol on the mortality of critically ill adult patients. Mayo Clin Proc 2004;79:992–1000.
  12. Malmberg K, Ryden L, Wedel H, Birkeland K, Bootsma A, Dickstein K, Efendic S, Fisher M, Hamsten A, Herlitz J, Hildebrandtb P, Macleod K, Laakso M, Torp-Pedersen C, Waldenstrom A: Intense metabolic control by means of insulin in patients with diabetes mellitus and acute myocardial infarction (DIGAMI 2): effects on mortality and morbidity. Eur Heart J 2005;26:650–661.
  13. Brunkhorst FM, Engel C, Bloos F, Meier-Hellmann A, Ragaller M, Weiler N, Moerer O, Gruendling M, Oppert M, Grond S, Olthoff D, Jaschinski U, John S, Rossaint R, Welte T, Schaefer M, Kern P, Kuhnt E, Kiehntopf M, Hartog C, Natanson C, Loeffler M, Reinhart K: Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med 2008;358:125–139.
  14. Vanhorebeek I, Langouche L, Van den Berghe G: Tight glucose control: what is the evidence? Crit Care Med2007;35:496–502.

    External Resources

  15. Vriesendorp TM, Devries JH, Hoekstra JB: Hypoglycemia and strict glycemic control in critically ill patients. Curr Opin Crit Care 2008;14:397–402.
  16. Hanazaki K, Maeda H, Okabayashi T: Tight perioperative glycemic control using an artificial endocrine pancreas. Surg Today 2010;40:1–7.
  17. Chaudhuri A, Janicke D, Wilson MF, Tripathy D, Garg R, Bandyopadhyay A, Calieri J, Hoffmeyer D, Syed T, Ghanim H, Aljada A, Dandona P: Anti-inflammatory and profibrinolytic effect of insulin in acute ST-segment-elevation myocardial infarction. Circulation 2004;109:849–854.
  18. Dandona P, Mohanty P, Chaudhuri A, Garg R, Aljada A: Insulin infusion in acute illness. J Clin Invest 2005;115:2277–2286.


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