{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,19]],"date-time":"2025-10-19T12:42:07Z","timestamp":1760877727013,"version":"build-2065373602"},"reference-count":30,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2010,9,17]],"date-time":"2010-09-17T00:00:00Z","timestamp":1284681600000},"content-version":"vor","delay-in-days":16,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Parenter Enteral Nutr"],"published-print":{"date-parts":[[2010,9]]},"abstract":"<jats:p><jats:italic>Background:<\/jats:italic> Early delivery of calories is important in critically ill patients, and the administration of parenteral nutrition (PN) is sometimes required to achieve this goal. However, PN can induce acute hyperglycemia, which is associated with adverse outcome. We hypothesized that initiation of PN using a rapid \u201cstep\u2010up\u201d approach, coupled with a computerized insulin\u2010dosing protocol, would result in a desirable caloric intake within 24 hours without causing hyperglycemia. <jats:italic>Methods:<\/jats:italic> In our surgical intensive care unit (ICU), glucose is regulated by a nurse\u2010centered computerized glucose regulation program. When adequate enteral feeding was not possible, PN was initiated according to a simple step\u2010up rule at an infusion rate of 10 mL\/h (approximately 10 kcal\/h) and subsequently increased by steps of 10 mL\/h every 4 hours, provided glucose was &lt;10 mmol\/L, until the target caloric intake (1 kcal\/kg\/h) was reached. All glucose levels and insulin doses were collected during the step\u2010up period and for 24 hours after achieving target feeding. <jats:italic>Results:<\/jats:italic> In all 23 consecutive patients requiring PN, mean intake was 1 kcal\/kg\/h within 24 hours. Of the 280 glucose samples during the 48\u2010hour study period, mean \u00b1 standard deviation glucose level was 7.4 \u00b1 1.4 mmol\/L. Only 4.5% of glucose measurements during the step\u2010up period were transiently \u226510 mmol\/L. After initiating PN, the insulin requirement rose from 1.1 \u00b1 1.5 units\/h to 2.9 \u00b1 2.5 units\/h (<jats:italic>P<\/jats:italic> &lt; .001). <jats:italic>Conclusions:<\/jats:italic> This proof of concept study shows that rapid initiation of PN using a step\u2010up approach coupled with computerized glucose control resulted in adequate caloric intake within 24 hours while maintaining adequate glycemic control.<\/jats:p>","DOI":"10.1177\/0148607110372390","type":"journal-article","created":{"date-parts":[[2010,9,17]],"date-time":"2010-09-17T18:11:36Z","timestamp":1284747096000},"page":"549-553","source":"Crossref","is-referenced-by-count":7,"title":["Computer\u2010Assisted Glucose Regulation During Rapid Step\u2010Wise Increases of Parenteral Nutrition in Critically Ill Patients"],"prefix":"10.1002","volume":"34","author":[{"given":"Miriam","family":"Hoekstra","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michiel A.","family":"Schoorl","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Iwan C. 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