First pilot trial of the STAR-Liege protocol for tight glycemic control in critically ill patients

Penning, Sophie; Compte, Aaron J. Le; Moorhead, Katherine T.; Desaive, Thomas; Massion, Paul; Preiser, Jean‐Charles; Chase, J. Geoffrey

doi:10.1016/j.cmpb.2011.07.003

Cited by 27 publications

(27 citation statements)

References 29 publications

(63 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…43 One possible limitation of this overall STAR framework and approach is the stochastic model. Its forecasting is at the center of all major advantages enabled by this approach.…”

Section: Discussionmentioning

confidence: 99%

Stochastic Targeted (STAR) Glycemic Control: Design, Safety, and Performance

Evans

Compte

Tan

et al. 2012

J Diabetes Sci Technol

Self Cite

105

View full text Add to dashboard Cite

Tight glycemic control (TGC) has shown benefits but has been difficult to achieve consistently. STAR (Stochastic TARgeted) is a flexible, model-based TGC approach that directly accounts for intra-and interpatient variability with a stochastically derived maximum 5% risk of blood glucose (BG) below 72 mg/dl. This research assesses the safety, efficacy, and clinical burden of a STAR TGC controller modulating both insulin and nutrition inputs in virtual and clinical pilot trials. Methods: Clinically validated virtual trials using data from 370 patients in the SPRINT (Specialized Relative Insulin and Nutrition Titration) study were used to design the STAR protocol and test its safety, performance, and required clinical effort prior to clinical pilot trials. Insulin and nutrition interventions were given every 1-3 h as chosen by the nurse to allow them to manage workload. Interventions were designed to maximize the overlap of the model-predicted (5-95 th percentile) range of BG outcomes with the 72-117 mg/dl band and thus provide a maximum 5% risk of BG <72 mg/dl. Interventions were calculated using clinically validated computer models of human metabolism and its variability in critical illness. Carbohydrate intake (all sources) was selected to maximize intake up to 100% of the American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM) goal (25 kg/kcal/h). Insulin doses were limited (8 U/h maximum), with limited increases based on current rate (0.5-2.0 U/h). Initial clinical pilot trials involved 3 patients covering ~450 h. Approval was granted by the Upper South A Regional Ethics Committee.

show abstract

“…43 One possible limitation of this overall STAR framework and approach is the stochastic model. Its forecasting is at the center of all major advantages enabled by this approach.…”

Section: Discussionmentioning

confidence: 99%

Stochastic Targeted (STAR) Glycemic Control: Design, Safety, and Performance

Evans

Compte

Tan

et al. 2012

J Diabetes Sci Technol

Self Cite

105

View full text Add to dashboard Cite

show abstract

“…The NICING model is a pharmacokinetic description of insulin-glucose dynamics in the preterm infant that uses the same fundamental dynamics as a clinically well-validated adult model of acute care hyperglcaemia [14][15][16]. This model is similar in fundamental dynamics to well-known type-1 diabetes models [17,18].…”

Section: Introductionmentioning

confidence: 99%

Brain mass estimation by head circumference and body mass methods in neonatal glycaemic modelling and control

Gunn

Dickson

Pretty

et al. 2014

Computer Methods and Programs in Biomedicine

Self Cite

View full text Add to dashboard Cite

show abstract

“…The difference of optimal c values between cool and warm suggests that the variation and stochastic modeling for both periods are different, leading to potentially different control requirements to ensure safe glycaemic control in these highly dynamic patients and states. In particular, c=1.0 is currently used in the STAR protocol (Evans et al 2012;Penning et al 2012) in Medical ICU patients. Hence, no change is required for the cool period.…”

Section: Cool Warmmentioning

confidence: 99%

Stochastic Modelling of Insulin Sensitivity for out of Hospital Cardiac Arrest Patients Treated with Hypothermia

Pri¹,

Chase²,

Pretty³

et al. 2016

J. of Biological Sciences

Self Cite

View full text Add to dashboard Cite

Hypothermia is often used to treat out of hospital cardiac arrest (OHCA) patients who often simultaneously receive insulin for stress induced hyperglycaemia. Variations in response to insulin reflect dynamic changes in insulin sensitivity (S I ), defined by the overall metabolic response to stress and therapy. Thus, tracking and forecasting this parameter is important to provide safe glycaemic control in highly dynamic patients. This study examines stochastic forecasting models of model-based S I variability in OHCA patients to assess the resulting potential impact of this therapy on glycaemic control quality and safety.

show abstract

First pilot trial of the STAR-Liege protocol for tight glycemic control in critically ill patients

Cited by 27 publications

References 29 publications

Stochastic Targeted (STAR) Glycemic Control: Design, Safety, and Performance

Stochastic Targeted (STAR) Glycemic Control: Design, Safety, and Performance

Brain mass estimation by head circumference and body mass methods in neonatal glycaemic modelling and control

Stochastic Modelling of Insulin Sensitivity for out of Hospital Cardiac Arrest Patients Treated with Hypothermia

Contact Info

Product

Resources

About