Second pilot trials of the STAR-Liege protocol for tight glycemic control in critically ill patients

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• 作者：Sophie Penning (2)
  Aaron J Le Compte (1)
  Paul Massion (6)
  Katherine T Moorhead (2)
  Christopher G Pretty (2)
  Jean-Charles Preiser (3)
  Geoffrey M Shaw (4) (5)
  Fatanah Suhaimi (1)
  Thomas Desaive (2)
  J Geoffrey Chase (1)
  
• 关键词：Glycemic control ; Critical care ; Intensive care unit ; Pilot trial
• 刊名：BioMedical Engineering OnLine
• 出版年：2012
• 出版时间：December 2012
• 年：2012
• 卷：11
• 期：1
• 全文大小：324KB
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  11. Lin J, Lee D, Chase JG, Shaw GM, Le Compte A, Lotz T, Wong J, Lonergan T, Hann CE: Stochastic modelling of insulin sensitivity and adaptive glycemic control for critical care. / Comput Methods Programs Biomed 2008,89(2):141-52. j.cmpb.2007.04.006">CrossRef
  12. Chase JG, Le Compte AJ, Suhaimi F, Shaw GM, Lynn A, Lin J, Pretty CG, Razak N, Parente JD, Hann CE, / et al.: Tight glycemic control in critical care–the leading role of insulin sensitivity and patient variability: a review and model-based analysis. / Comput Methods Programs Biomed 2011,102(2):156-71. j.cmpb.2010.11.006">CrossRef
  13. Pretty CG, Le Compte AJ, Chase JG, Shaw GM, Preiser JC, Penning S, Desaive T: Variability of insulin sensitivity during the first 4 days of critical illness: Implications for tight glycaemic control. / Annals of Intensive Care 2012,2(1):17. CrossRef
  14. Chase J, Shaw GM, Wong XW, Lotz T, Lin J, Hann CE: Model-based glycaemic control in critical care - A review of the state of the possible. / Biomedical Signal Processing and Control 2006,1(1):3-1. j.bspc.2006.03.002">CrossRef
  15. Chase JG, Shaw GM, Lotz T, LeCompte A, Wong J, Lin J, Lonergan T, Willacy M, Hann CE: Model-based insulin and nutrition administration for tight glycaemic control in critical care. / Curr Drug Deliv 2007,4(4):283-96. CrossRef
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• 作者单位：Sophie Penning (2)
  Aaron J Le Compte (1)
  Paul Massion (6)
  Katherine T Moorhead (2)
  Christopher G Pretty (2)
  Jean-Charles Preiser (3)
  Geoffrey M Shaw (4) (5)
  Fatanah Suhaimi (1)
  Thomas Desaive (2)
  J Geoffrey Chase (1)
  
  2. Cardiovascular Research Centre, Institut de Physique, Université de Liege, Institut de Physics, Allée du 6 Ao?t, 17 (Bat B5), Liege, B4000 Liege, Liege, Belgium
  1. Dept of Mechanical Eng, Centre for Bio-Engineering, University of Canterbury, Private Bag 4800, 8054, Christchurch, New Zealand
  6. Dept of Intensive Care, CHU, Liege, Belgium
  3. Dept of Intensive Care, Erasme University Hospital, 808 route de Lennik, Brussels, B1070, Belgium
  4. University of Otago Christchurch, School of Medicine, Christchurch, 8054, New Zealand
  5. Dept of Intensive Care, Christchurch Hospital, Christchurch, 8054, New Zealand
  
• ISSN：1475-925X

文摘

Background Critically ill patients often present increased insulin resistance and stress-induced hyperglycemia. Tight glycemic control aims to reduce blood glucose (BG) levels and variability while ensuring safety from hypoglycemia. This paper presents the results of the second Belgian clinical trial using the customizable STAR framework in a target-to-range control approach. The main objective is reducing measurement frequency while maintaining performance and safety of the glycemic control. Methods The STAR-Liege 2 (SL2) protocol targeted the 100-40 mg/dL glycemic band and offered 2-hourly and 3-hourly interventions. Only insulin rates were adjusted, and nutrition inputs were left to the attending clinicians. This protocol restricted the forecasted risk of BG-lt;-0 mg/dL to a 5% level using a stochastic model of insulin sensitivity to assess patient-specific responses to insulin and its future likely variability to optimize insulin interventions. The clinical trial was performed at the Centre Hospitalier Universitaire de Liege and included 9 patients. Results are compared to 24-hour pre-trial and 24-hour post-trial, but also to the results of the first pilot trial performed in Liege, STAR-Liege 1 (SL1). This trial was approved by the Ethics Committee of the Medical Faculty of the University of Liege (Liege, Belgium). Results During the SL2 trial, 91 measurements were taken over 194 hours. BG levels were tightly distributed: 54.9% of BG within 100-40 mg/dL, 40.7% were?≥-40 mg/dL and 4.4% were-lt;-00 mg/dL with no BG-lt;-0 mg/dL. Comparing these results with 24-hour pre-trial and post-trial shows that SL2 reduced high and low BG levels and reduced glycemic variability. Nurses selected 3-hourly measurement only 5 of 16 times and overrode 12% of 91 recommended interventions (35% increased insulin rates and 65% decreased insulin rates). SL1 and SL2 present similar BG levels distribution (p-gt;-.05) with significantly reduced measurement frequency for SL2 (p-lt;-.05). Conclusions The SL2 protocol succeeded in reducing clinical workload while maintaining safety and effectiveness of the glycemic control. SL2 was also shown to be safer and tighter than hospital control. Overall results validate the efficacy of significantly customizing the STAR framework.