Poster (Scientific congresses and symposiums)
Stochastic TARgeted (STAR) glycaemic control: improved performances and safety for all
Uyttendaele, Vincent; Knopp, Jennifer L.; PIROTTE, Marc et al.
2020Reanimation 2020
 

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Keywords :
Glycemic control; Insulin sensitivity; Intensive Care
Abstract :
[en] Rationale: Whether more intensive glycemic control (GC) is beneficial or harmful for critically ill patient has been debated over the last decades. GC has been shown hard to achieve safely and effectively in intensive care. The associated increased hypoglycemia and glycemic variability is associated with worsened outcomes. However, model-based risk-based dosing approach have recently shown potential benefits, improving significantly GC safety and performances. Objective: The Stochastic TARgeted (STAR) GC framework is a model-based controller using a unique risk-based dosing approach. STAR identifies model-based patient-specific insulin sensitivity and assesses its potential variability over the next hours. These predictions are used to assess hypoglycemic risks associated with a specific insulin and/or nutrition intervention to reach a specific target band. This study analyzes preliminary clinical trial results of STAR in a Belgian ICU compared to the local standard protocol (SP). Patients and Methods: Ethics approval was granted by the local University Hospital Ethics Committee. Patient are included if two BG measurements > 145 mg/dL. STAR target band is 80-145 mg/dL compared to 100-150mg/dL for the SP. Nutrition is administered enterally, and insulin infusion intra-venously. GC is stopped if BG is stable (6 hours in target band) or after 72 hours of control. Safety is assessed by %BG <80mg/dL and %BG >180 mg/dL. Performance is assessed by %BG in target band. Clinical data from 10 patients is used and compared to 20 retrospective patients under the SP. Results: STAR outperformed the SP. Results summary is presented in Table 1. Despite the lower BG target, STAR safety was improved with lower %BG<80mg/dL (0.5% vs. 1%), and significantly lower %BG>145 mg/dL (11% vs. 44%) and %BG>180mg/dL (2% vs 13%). STAR was highly effective with 89% BG in target band compared to 54% for the SP. Median [IQR] BG and nutrition rates achieved were lower for STAR (118 [109 129] vs. 139 [117 160] mg/dL and 7.0 [4.7 8.2] vs. 9.8 [8.6 11.5] g/h), while higher insulin rates were administered in STAR (3.0 [2.0 4.0] vs. 2.5 [2.0 3.0] U/h). However, workload was increased under STAR (12 vs. 7 measurements per day), as expected from measurement interval difference between STAR (3-hourly) and the SP (4-hourly). Conclusion: This unique patient-specific risk-based dosing approach GC framework was successful in controlling all patients safely and effectively. These preliminary results are encouraging and show GC can be achieved safely and effectively at lower target bands. In turns, these improved GC outcomes could improve patient outcomes.
Disciplines :
Anesthesia & intensive care
Engineering, computing & technology: Multidisciplinary, general & others
Author, co-author :
Uyttendaele, Vincent ;  Université de Liège - ULiège > In silico-Model-based therapeutics, Critical Care Basic Sc.
Knopp, Jennifer L.
PIROTTE, Marc ;  Centre Hospitalier Universitaire de Liège - CHU > Département infirmier > Soins intensifs médecine interne (-2C)
MORIMONT, Philippe ;  Centre Hospitalier Universitaire de Liège - CHU > Autres Services Médicaux > Service des soins intensifs
Shaw, Geoffrey M.
Desaive, Thomas  ;  Université de Liège - ULiège > Département d'astrophys., géophysique et océanographie (AGO) > Thermodynamique des phénomènes irréversibles
Chase, J. Geoffrey
Misset, Benoît ;  Centre Hospitalier Universitaire de Liège - CHU > Autres Services Médicaux > Service des soins intensifs
LAMBERMONT, Bernard  ;  Centre Hospitalier Universitaire de Liège - CHU > Autres Services Médicaux > Service des soins intensifs
Language :
English
Title :
Stochastic TARgeted (STAR) glycaemic control: improved performances and safety for all
Publication date :
07 January 2020
Event name :
Reanimation 2020
Event organizer :
SRLF
Event place :
Paris, France
Event date :
5-7 February 2020
Audience :
International
Available on ORBi :
since 14 March 2020

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