| Title |
Safety, efficacy and clinical generalization of the STAR protocol: a retrospective analysis
|
|---|---|
| Published in |
Annals of Intensive Care, March 2016
|
| DOI | 10.1186/s13613-016-0125-9 |
| Pubmed ID | |
| Authors |
Kent W. Stewart, Christopher G. Pretty, Hamish Tomlinson, Felicity L. Thomas, József Homlok, Szabó Némedi Noémi, Attila Illyés, Geoffrey M. Shaw, Balázs Benyó, J. Geoffrey Chase |
| Abstract |
The 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. Retrospective 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. Both 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 %). STAR 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. |
X Demographics
The data shown below were collected from the profiles of 2 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| France | 1 | 50% |
| Spain | 1 | 50% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 1 | 50% |
| Practitioners (doctors, other healthcare professionals) | 1 | 50% |
Mendeley readers
The data shown below were compiled from readership statistics for 67 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Colombia | 1 | 1% |
| Unknown | 66 | 99% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Student > Master | 10 | 15% |
| Other | 9 | 13% |
| Researcher | 9 | 13% |
| Student > Postgraduate | 5 | 7% |
| Student > Doctoral Student | 4 | 6% |
| Other | 15 | 22% |
| Unknown | 15 | 22% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 15 | 22% |
| Engineering | 13 | 19% |
| Nursing and Health Professions | 9 | 13% |
| Biochemistry, Genetics and Molecular Biology | 2 | 3% |
| Sports and Recreations | 2 | 3% |
| Other | 7 | 10% |
| Unknown | 19 | 28% |
Attention Score in Context
This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 10 May 2016.
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#19,054,237
of 23,613,071 outputs
Outputs from Annals of Intensive Care
#939
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Outputs of similar age from Annals of Intensive Care
#23
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