Acute Respiratory Distress Syndrome (ARDS) patients require mechanical ventilation (MV) for breathing support. Patient-specific PEEP is encouraged treating different but there no well established method in optimal selection.A study of 10 diagnosed with ALI/ARDS whom underwent recruitment manoeuvre carried out. Airway pressure and flow data are used to identify patient-specific constant lung elastance (E lung) time-variant dynamic drs) at each level (increments 5 cm H2O), a single compartment...

Abstract Introduction Intensive care unit mortality is strongly associated with organ failure rate and severity. The sequential assessment (SOFA) score used to evaluate the impact of a successful tight glycemic control (TGC) intervention (SPRINT) on failure, morbidity, thus mortality. Methods A retrospective analysis 371 patients (3,356 days) SPRINT (August 2005 - April 2007) 413 (3,211 from two years prior, matched by Acute Physiology Chronic Health Evaluation (APACHE) III. SOFA calculated...

Accurate glycemic control (AGC) is difficult due to excessive hypoglycemia risk. Stochastic TARgeted (STAR) forecasts changes in insulin sensitivity calculate a range of outcomes for an intervention, creating risk framework improve safety and performance. An improved, simplified STAR was developed reduce light clinical effort, while improving nutrition rates Blood glucose (BG) levels are targeted 80-145 mg/dL, using 1-3 h interventions. Insulin limited +3U/h ±30% goal rate (minimum 30%). All...

Introduction: Tight glycemic control (TGC) has shown benefits but been difficult to achieve consistently. STAR (Stochastic TARgeted) is a flexible, model-based TGC approach that directly accounts for intra- and interpatient variability with stochastically derived maximum 5% risk of blood glucose (BG) below 72 mg/dl. This research assesses the safety, efficacy, clinical burden controller modulating both insulin nutrition inputs in virtual pilot trials. Methods: Clinically validated trials...

In-silico virtual patients and trials offer significant advantages in cost, time safety for designing effective tight glycemic control (TGC) protocols. However, no such method has fully validated the independence of (or resulting clinical trial predictions) from data used to create them. This study uses matched cohorts a TGC validate in-silico models methods.Data 211 patient subset Glucontrol Liege, Belgium. Glucontrol-A (N = 142) targeted 4.4-6.1 mmol/L Glucontrol-B 69) 7.8-10.0 mmol/L....

Derivative based a-priori structural identifiability analyses of mathematical models can offer valuable insight into the model parameters. However, these are only capable a binary confirmation distinction parameters and positive outcome begin to lose relevance when measurement error is introduced. This article presents an integral method that allows observation with two-parameters in presence assay error. The measures formulations parameter coefficients at proposed sampling times. It thus...

Tight glycemic control (TGC) has shown benefits but been difficult to achieve consistently. STAR (Stochastic TARgeted) is a flexible, model-based TGC approach directly accounting for intra- and inter- patient variability with stochastically derived maximum 5% risk of blood glucose (BG) < 4.0 mmol/L. This research assesses the safety, efficacy, clinical burden controller modulating both insulin nutrition inputs in pilot trials.Seven patients covering 660 hours. Insulin interventions are given...

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 cause variable glycemia. This study quantifies compares daily evolution level for patients receiving TGC.This a retrospective analysis data from SPRINT TGC involving admitted mixed medical-surgical ICU August 2005 May 2007....

Real-time patient respiratory mechanics estimation can be used to guide mechanical ventilation settings, particularly, positive end-expiratory pressure (PEEP). This work presents a software, Clinical Utilisation of Respiratory Elastance (CURE Soft), using time-varying elastance model offer this ability aid in treatment.CURE Soft is desktop application developed JAVA. It has two modes operation, 1) Online real-time monitoring decision support and, 2) Offline for user education purposes,...

BackgroundRespiratory mechanics models can aid in optimising patient-specific mechanical ventilation (MV), but the applications are limited to fully sedated MV patients who have little or no spontaneously breathing efforts. This research presents a time-varying elastance (Edrs) model that be used determine their respiratory mechanics. MethodsA is developed with negative elastic component (Edemand), describe driving pressure generated during patient initiated cycle. Data from 22 partially...

Hyperglycaemia is associated with adverse outcomes in the intensive care unit, and initial studies suggested outcome benefits of glycaemic control (GC). However, subsequent often failed to replicate these results, they were unable achieve consistent, safe control, raising questions about benefit or harm GC as well nature association glycaemia mortality clinical outcomes. In this study, we evaluated if non-survivors are harder than survivors determined a function patient condition eventual...

Elevated blood glucose (BG) concentrations (Hyperglycaemia) are a common complication in critically ill patients. Insulin therapy is commonly used to treat hyperglycaemia, but metabolic variability often results poor BG control and low (hypoglycaemia).This paper presents model-based virtual trial method for glycaemic protocol design, evaluates its generalisability across different populations.Model-based insulin sensitivity (SI) was create patients from clinical data three ICUs New Zealand,...

The aim of this study was to test whether the simple ratio right ventricular (RV) end-systolic pressure (Pes) stroke volume (SV), known as effective arterial elastance (Ea), provides a valid assessment pulmonary load in case embolism- or endotoxin-induced hypertension. Ventricular pressure-volume (PV) data (obtained with conductance catheters) and invasive flow waveforms were simultaneously recorded two groups six pure Pietran pigs, submitted either embolism (group A) endotoxic shock B)....

Critically ill patients are highly variable in their response to care and treatment. This variability the search for improved outcomes have led a significant increase use of protocolized reduce care. However, does not address outcome due inter- intra-patient variability, both physiological state, disease lack patient-specificity defines opportunity patient-specific approaches diagnosis, care, patient management, which complementary to, fit within, approaches.Computational models human...

Introduction:Tight glycemic control (TGC) remains controversial while successful, consistent, and effective protocols remain elusive. This research analyzes data from two TGC trials for root causes of the differences achieved in thus potentially other outcomes. The goal is to uncover aspects successful delineate impact cohorts. Methods:A retrospective analysis was conducted using records a 211-patient subset GluControl trial taken Liege, Belgium, 393 patients Specialized Relative Insulin...

The optimal level of positive end-expiratory pressure (PEEP) is still widely debated in treating acute respiratory distress syndrome (ARDS) patients. Current methods selecting PEEP only provide a range values and do not unique patient-specific solutions. Model-based offer novel way using non-invasive pressure-volume (PV) measurements to estimate patient recruitability. This paper examines the clinical viability such models pilot trials assist therapy, optimise PEEP, assess disease state...

Model-based methods can be used to characterise patient-specific condition and response mechanical ventilation (MV) during treatment for acute respiratory distress syndrome (ARDS). Conventional metrics of mechanics are based on inspiration only, neglecting data from the expiration cycle. However, it is hypothesised that expiratory determine an alternative metric, offering another means track patient guide positive end pressure (PEEP) selection.Three fully sedated, oleic acid induced ARDS...

Selecting positive end-expiratory pressure (PEEP) during mechanical ventilation is important, as it can influence disease progression and outcome of acute respiratory distress syndrome (ARDS) patients. However, there are no well-established methods for optimizing PEEP selection due to the heterogeneity ARDS. This research investigates viability titrating minimum elastance mechanically ventilated ARDS patients.Ten patients from Christchurch Hospital Intensive Care Unit were included in this...