9 results for Preiser, J-C.

  • Evolution of insulin sensitivity and its variability in out of hospital cardiac arrest (OHCA) patients treated with hypothermia

    Sah Pri, A.; Chase, J.G.; Pretty, C.G.; Shaw, G.M.; Preiser, J-C.; Vincent, J-L.; Oddo, M.; Taccone, F.; Penning, S.; Desaive, T. (2014)

    Journal Articles
    University of Canterbury Library

    Therapeutic hypothermia (TH) is often used to treat out-of-hospital cardiac arrest (OHCA) patients who also often simultaneously receive insulin for stress-induced hyperglycaemia. However, the impact of TH on systemic metabolism and insulin resistance in critical illness is unknown. This study analyses the impact of TH on metabolism, including the evolution of insulin sensitivity (SI) and its variability, in patients with coma after OHCA.

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  • Does the achievement of an intermediate glycemic target reduce organ failure and mortality? A post hoc analysis of the Glucontrol trial

    Penning, S.; Chase, J.G.; Preiser, J-C.; Pretty, C.G.; Signal, M.; Melot, C.; Desaive, T. (2014)

    Journal Articles
    University of Canterbury Library

    This research evaluates the impact of the achievement of an intermediate target glycemic band on the severity of organ failure and mortality.

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  • Variability of insulin sensitivity during the first 4 days of critical illness: Implications for tight glycaemic control

    Pretty, C.G.; Le Compte, A.J.; Chase, J.G.; Shaw, G.M.; Preiser, J-C.; Penning, S.; Desaive, T. (2012)

    Journal Articles
    University of Canterbury Library

    Background: Effective tight glycemic control (TGC) can improve outcomes in critical care patients, but it is difficult to achieve consistently. Insulin sensitivity defines the metabolic balance between insulin concentration and insulin-mediated glucose disposal. Hence, variability of insulin sensitivity can cause variable glycemia. This study quantifies and compares the daily evolution of insulin sensitivity level and variability for critical care patients receiving TGC. Methods: This is a retrospective analysis of data from the SPRINT TGC study involving patients admitted to a mixed medical-surgical ICU between August 2005 and May 2007. Only patients who commenced TGC within 12 hours of ICU admission and spent at least 24 hours on the SPRINT protocol were included (N = 164). Model-based insulin sensitivity (SI) was identified each hour. Absolute level and hour-to-hour percent changes in SI were assessed on cohort and per-patient bases. Levels and variability of SI were compared over time on 24-hour and 6-hour timescales for the first 4 days of ICU stay. Results: Cohort and per-patient median SI levels increased by 34% and 33% (p<0.001). For 72% of the cohort, median SI on day 2 was higher than on day 1. The day 1–2 results are the only clear, statistically significant trends across both analyses. Analysis of the first 24 hours using 6-hour blocks of SI data showed that most of the improvement in insulin sensitivity level and variability seen between days 1 and 2 occurred during the first 12–18 hours of day 1. Conclusions: Critically ill patients have significantly lower and more variable insulin sensitivity on day 1 than later in their ICU stay and particularly during the first 12 hours. This rapid improvement is likely due to the decline of counter-regulatory hormones as the acute phase of critical illness progresses. Clinically, these results suggest that while using TGC protocols with patients during their first few days of ICU stay, extra care should be afforded. Increased measurement frequency, higher target glycemic bands, conservative insulin dosing, and modulation of carbohydrate nutrition should be considered to minimize safely the outcome glycemic variability and reduce the risk of hypoglycemia.

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  • Tight Glycemic Control in Critical Care - The leading role of insulin sensitivity and patient variability – A review and model-based analysis

    Chase, J.G.; Le Compte, A.J.; Suhaimi, F.; Shaw, G.M.; Lynn, A.; Lin, J.; Pretty, C.G.; Razak, N.N.; Parente, J.D.; Hann, C.E.; Preiser, J-C.; Desaive, T. (2011)

    Journal Articles
    University of Canterbury Library

    Tight glycemic control (TGC) has emerged as a major research focus in critical care due to its potential to simultaneously reduce both mortality and costs. However, repeating initial successful TGC trials that reduced mortality and other outcomes has proven difficult with more failures than successes. Hence, there has been growing debate over the necessity of TGC, its goals, the risk of severe hypoglycemia, and target cohorts. This paper provides a review of TGC via new analyses of data from several clinical trials, including SPRINT, Glucontrol and a recent NICU study. It thus provides both a review of the problem and major background factors driving it, as well as a novel model-based analysis designed to examine these dynamics from a new perspective. Using these clinical results and analysis, the goal is to develop new insights that shed greater light on the leading factors that make TGC difficult and inconsistent, as well as the requirements they thus impose on the design and implementation of TGC protocols. A model-based analysis of insulin sensitivity using data from three different critical care units comprising over 75,000 hours of clinical data is used to analyse variability in metabolic dynamics using a clinically validated model-based insulin sensitivity metric (SI). Variation in SI provides a new interpretation and explanation for the variable results seen (across cohorts and studies) in applying TGC. In particular, significant intra- and inter- patient variability in insulin resistance (1/ SI) is seen be a major confounder that makes TGC difficult over diverse cohorts, yielding variable results over many published studies and protocols. Further factors that exacerbate this variability in glycemic outcome are found to include measurement frequency and whether a protocol is blind to carbohydrate administration.

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  • Glycemic Variability, Hypoglycemia and Organ Failure in the Glucontrol Study

    Penning, S.; Le Compte, A.J.; Preiser, J-C.; Chase, J.G.; Desaive, T. (2011)

    Conference Contributions - Other
    University of Canterbury Library

    Organ failure is the leading cause of intensive care unit (ICU) mortality. This research evaluates the influence of glycemic variability and hypoglycemia on organ failure rate. The analysis uses data from the Glucontrol study and results show that high glycemic variability and hypoglycemia are both associated with increased SOFA score, and thus increased organ failure rate.

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  • What Makes Tight Glycemic Control Tight? The Impact of Variability and Nutrition in Two Clinical Studies

    Suhaimi, F.; LeCompte, A.J.; Preiser, J-C.; Shaw, G.M.; Massion, P.; Radermecker, R.P.; Pretty, C.G.; Lin, J.; Desaive, T.; Chase, J.G. (2010)

    Journal Articles
    University of Canterbury Library

    Tight glycemic control (TGC) remains controversial, and successful, consistent and effective protocols elusive. This research analyses data from 2 TGC trials for root causes of the differences achieved in control and thus potentially in glycemic and other outcomes. The goal is to uncover aspects of successful TGC and delineate the impact of differences in cohorts. Protocols that dose insulin blind to carbohydrate administration can suffer greater outcome glycemic variability, even if average cohort glycemic targets are met. While the cohorts varied significantly in model-assessed insulin resistance, their variability was similar. Such significant intra- and inter- patient variability is a further significant cause and marker of glycemic variability in TGC. The results strongly recommended that TGC protocols be explicitly designed to account for significant intra- and inter- patient variability in insulin resistance, as well as specifying or having knowledge of carbohydrate administration to minimise variability in glycemic outcomes across diverse cohorts and/or centres.

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  • Organ Failure and Tight Glycemic Control in the SPRINT Study

    Chase, J.G.; Pretty, C.G.; Pfeifer, L.; Shaw, G.M.; Preiser, J-C.; Lin, J.; Hewett, D.; Moorhead, K.T.; Desaive, T.; LeCompte, A.J. (2010)

    Journal Articles
    University of Canterbury Library

    open access

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  • Pilot Trials of the STAR TGC Protocol in a Cardiac Surgery ICU

    LeCompte, A.J.; Penning, S.; Moorhead, K.T.; Massion, P.; Preiser, J-C.; Shaw, G.M.; Desaive, T.; Chase, J.G. (2010)

    Conference Contributions - Other
    University of Canterbury Library

    MD, 1-page.

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  • Why Protocolised care works in my unit

    Shaw, G.M.; Chase, J.G.; Pfeiffer, L.; Preiser, J-C.; Desaive, T.; Pretty, C.G.; Suhaimi, F. (2010)

    Conference Contributions - Other
    University of Canterbury Library

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