Routine insulin sliding scale protocol versus software driven algorithm (star protocol) for blood glucose management of critically ill patients in the ICU: A prospective observational study / Tan Ru Yi
The objective of the study was to evaluate a specifically designed software driven algorithm for the establishment of tight glycaemic control with lesser risks of potentially harmful hypoglycaemia in critically ill patients in the ICU and to compare the results with the routine glucose management...
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| Format: | Thesis |
| Published: |
2018
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| Subjects: | |
| Online Access: | http://studentsrepo.um.edu.my/11191/8/ru_yi.pdf http://studentsrepo.um.edu.my/11191/ |
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| Summary: | The objective of the study was to evaluate a specifically designed software driven
algorithm for the establishment of tight glycaemic control with lesser risks of
potentially harmful hypoglycaemia in critically ill patients in the ICU and to compare
the results with the routine glucose management protocol i.e. insulin sliding scale, used
by the ICU in UMMC. A total of 82 patient�s that were admitted to the ICU requiring
glucose management protocols were recruited for this study. This was a prospective
observational study conducted over a duration of 1 year. Biometric data, feeding and
fluid regimens, vital signs and laboratory parameters (haematological, metabolic and
biochemical results) were extracted and collected from the patient�s hospital ICU
records. The data collected was subsequently simulated with the software driven
algorithm (STAR protocol) and results were analysed to determine if it was better at
maintaining blood glucose levels within set targets of 6-10 mmol/L. Analysis of the
entire cohort showed that statistically there was no significant difference between the
ISS protocol with the STAR protocol in maintaining glucose control within the set
targets of 6-10 mmol/L with a p-value of 0.1556, z-value of -1.42404 and U value of
2928.5. However, the incidence of severe hypoglycaemic events (BG < 2.2 mmol/L)
was 0.05% using the ISS arm whereas there was no incidence of hypoglycaemia in the
STAR protocol arm. Despite both arms showing similar performance in terms of BG
therapy, there is still much room for improvement with the STAR protocol as
simulations were made based on Caucasian population pharmacokinetic and
pharmacodynamics models. Hence, further work and research in the area of software
development and customisation to local epidemiology is required to validate it for use in
our clinical practice. |
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