مؤتمر
STAR-3D Clinical Trial Results: Improved performance and safety
| العنوان: | STAR-3D Clinical Trial Results: Improved performance and safety |
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| المؤلفون: | Uyttendaele, Vincent, Knopp, Jennifer L., Desaive, Thomas, Chase, J. Geoffrey |
| المصدر: | IFAC-PapersOnLine, 54 (15), 1-580 (2021); 11th IFAC Symposium on Biological and Medical Systems BMS 2021, Ghent, Belgium [BE], 19-22 Septembre 2021 |
| بيانات النشر: | Elsevier, 2021. |
| سنة النشر: | 2021 |
| مصطلحات موضوعية: | Glycemic control, Hyperglycemia, Insulin sensitivity, Human health sciences, Anesthesia & intensive care, Endocrinology, metabolism & nutrition, Engineering, computing & technology, Sciences de la santé humaine, Anesthésie & soins intensifs, Endocrinologie, métabolisme & nutrition, Ingénierie, informatique & technologie |
| الوصف: | Glycemic control (GC) has improved outcomes for intensive care unit (ICU) patients. However, the increased risk of hypoglycemia and glycemic variability due to inter- and intra- patient variability make safe, effective GC difficult. Stochastic TARgeted (STAR) GC framework is a unique, patient-specific, risk-based dosing protocol directly accounting for both inter- and intra- patient variability using a stochastic model of future patient variability. A new tri-variate (3D) stochastic model, developed and validated in virtual trials to provide more accurate future predictions of insulin sensitivity (SI), is clinically evaluated.STAR-3D was implemented as standard care at the Christchurch Hospital ICU, New Zealand, between April 2019 and January 2021. In total, 567 patients (33276 hours) were treated. The overall median [IQR] BG achieved was 6.7 [6.0 7.8] mmol/L with 76% BG in the 4.4-8.0 mmol/L target band. Importantly, there were only 0.3% BG < 4.0 mmol/L (mild hypoglycemia) and no incidence of severe hypoglycemia (BG < 2.2 mmol/L). These outcomes were achieved with median [IQR] 4.0 [2.0 6.0] U/h insulin and median [IQR] nutrition delivery of 99 [80 100]% goal feed (GF). Similar safety and performance BG outcomes were obtained at a per-patient level, suggesting STAR-3D successfully provided safe, effective control for all patients, regardless of patient condition. Compared to the original version of STAR, STAR-3D provided improved safety and efficacy, while achieving higher nutrition delivery.The new 3D stochastic model in STAR-3D provided higher safety and efficacy for all patients in this large clinical trial, despite using higher insulin rates than its predecessor to provide greater nutrition delivery. STAR-3D thus better captured patient-specific condition and variability to provide improved GC outcomes. |
| نوع الوثيقة: | conference paper http://purl.org/coar/resource_type/c_5794 conferenceObject peer reviewed |
| اللغة: | English |
| Relation: | urn:issn:2405-8971; urn:issn:2405-8963 |
| DOI: | 10.1016/j.ifacol.2021.10.304 |
| URL الوصول: | https://orbi.uliege.be/handle/2268/264718 |
| حقوق: | open access http://purl.org/coar/access_right/c_abf2 info:eu-repo/semantics/openAccess |
| رقم الأكسشن: | edsorb.264718 |
| قاعدة البيانات: | ORBi |
| DOI: | 10.1016/j.ifacol.2021.10.304 |
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