ArticleAnnals of intensive care2016
Safety, efficacy and clinical generalization of the STAR protocol: a retrospective analysis.
Article in Annals of intensive care, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers.
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Who cites it
27 citing papers in PubMed.
- Software-guided versus nurse-directed blood glucose control in critically ill patients: the LOGIC-2 multicenter randomized controlled clinical trial.Critical care (London, England) · 2017Trial
- Determining Losses in Jet Injection Subcutaneous Insulin Delivery: A Model-Based Approach.Journal of diabetes science and technology · 2023Article
- Estimating Enhanced Endogenous Glucose Production in Intensive Care Unit Patients with Severe Insulin Resistance.Journal of diabetes science and technology · 2022Article
- The Impact of Exogenous Insulin Input on Calculating Hepatic Clearance Parameters.Journal of diabetes science and technology · 2022Article
- Stochastic Modelling of Respiratory System Elastance for Mechanically Ventilated Respiratory Failure Patients.Annals of biomedical engineering · 2021Observational
- Estimating Increased EGP During Stress Response in Critically Ill Patients.Journal of diabetes science and technology · 2021Article
- Insulin sensitivity in critically ill patients: are women more insulin resistant?Annals of intensive care · 2021Article
- Increased insulin resistance in intensive care: longitudinal retrospective analysis of glycaemic control patients in a New Zealand ICU.Therapeutic advances in endocrinology and metabolism · 2021Article
- Risk-Based Care: Let's Think Outside the Box.Frontiers in medicine · 2021Article
- Algorithm Maxima for Intravenous Insulin Infusion.Diabetes technology & therapeutics · 2020Article
- Risk and reward: extending stochastic glycaemic control intervals to reduce workload.Biomedical engineering online · 2020Article
- Assessment of Glycemic Control Protocol (STAR) Through Compliance Analysis Amongst Malaysian ICU Patients.Medical devices (Auckland, N.Z.) · 2020Article
- 3D kernel-density stochastic model for more personalized glycaemic control: development and in-silico validation.Biomedical engineering online · 2019Article
- Glucose control in the ICU.Current opinion in anaesthesiology · 2019Review
- Optimising mechanical ventilation through model-based methods and automation.Annual reviews in control · 2019Review
- Model-based glycemic control in a Malaysian intensive care unit: performance and safety study.Medical devices (Auckland, N.Z.) · 2019Article
- Interpretation of Retrospective BG Measurements.Journal of diabetes science and technology · 2018Article
- Improving glycemic control in critically ill patients: personalized care to mimic the endocrine pancreas.Critical care (London, England) · 2018Review
- Hypoglycemia Prevention by Algorithm Design During Intravenous Insulin Infusion.Current diabetes reports · 2018Review
- Critical Care Management of Stress-Induced Hyperglycemia.Current diabetes reports · 2018Review
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Authors and funding
10 authors.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundThe changes in metabolic pathways and metabolites due to critical illness result in a highly complex and dynamic metabolic state, making safe, effective management of hyperglycemia and hypoglycemia difficult. In addition, clinical practices can vary significantly, thus making GC protocols difficult to generalize across units.The aim of this study was to provide a retrospective analysis of the safety, performance and workload of the stochastic targeted (STAR) glycemic control (GC) protocol to demonstrate that patient-specific, safe, effective GC is possible with the STAR protocol and that it is also generalizable across/over different units and clinical practices.
methodsRetrospective analysis of STAR GC in the Christchurch Hospital Intensive Care Unit (ICU), New Zealand (267 patients), and the Gyula Hospital, Hungary (47 patients), is analyzed (2011-2015). STAR Christchurch (BG target 4.4-8.0 mmol/L) is also compared to the Specialized Relative Insulin and Nutrition Tables (SPRINT) protocol (BG target 4.4-6.1 mmol/L) implemented in the Christchurch Hospital ICU, New Zealand (292 patients, 2005-2007). Cohort mortality, effectiveness and safety of glycemic control and nutrition delivered are compared using nonparametric statistics.
resultsBoth STAR implementations and SPRINT resulted in over 86 % of time per episode in the blood glucose (BG) band of 4.4-8.0 mmol/L. Patients treated using STAR in Christchurch ICU spent 36.7 % less time on protocol and were fed significantly more than those treated with SPRINT (73 vs. 86 % of caloric target). The results from STAR in both Christchurch and Gyula were very similar, with the BG distributions being almost identical. STAR provided safe GC with very few patients experiencing severe hypoglycemia (BG < 2.2 mmol/L, <5 patients, 1.5 %).
conclusionsSTAR outperformed its predecessor, SPRINT, by providing higher nutrition and equally safe, effective control for all the days of patient stay, while lowering the number of measurements and interventions required. The STAR protocol has the ability to deliver high performance and high safety across patient types, time, clinical practice culture (Christchurch and Gyula) and clinical resources.
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