Comparison of modulated and clinically set nutrition protocol’s for STAR

摘要

Introduction: Hyperglycaemia is common in intensive care units (ICU’s) and is associated with negative clinical outcomes. One ICU aim is to provide the highest nutrition possible, while achieving normo-glycaemic blood glucose (BG) levels. The best nutrition delivery method and amount is controversial and highly debated. STAR is a proven glucose control (GC) method providing nutrition at or near to that achieved by the best ICU’s in the world, while also achieving safe and effective GC. This study analyses the key outcomes of STAR’s modulated insulin and nutrition protocol (STAR), and a clinically set nutrition protocol with STAR’s insulin only control (STAR-IO). This comparison separates the effect of controlling insulin and nutrition, vs using insulin alone to control glucose.Methods: BG measurements for patients treated with STAR (N = 221; 2011 - 2015) and STAR-IO (N = 194; 2016 - 2017) are evaluated for GC performance, safety, and workload. Mean nutrition delivery over the first 7 days of ICU stay for both cohorts was analysed, including assessment of unfed hours.Results: Patient cohorts were similar in age, sex and length of GC (median ~ 2days). The BG levels achieved by STAR were significantly lower than STAR-IO (median 6.8 vs 7.9 mmol/L, P < 0.05). 34% more BG measurements were in the normo-glycaemic range (4.0 - 8.0 mmol/L) for STAR. %BG < 4.0 mmol/L was very low in both cases indicating equivalent safety. STAR’s nutrition delivery rates were 63% and 20% higher, respectively, on the first 2 days of ICU stay than under STAR-IO. After 2 days, nutrition delivery rates were within 9% but STAR remained higher. Additionally, under STAR only 14.4% hours of treatment on GC were unfed compared to STAR-IO’s 22.3% (P < 0.05). STAR-IO required approximately 4 more BG measurements (+ 30%) on average per day than STAR (16.5 vs 12.7 measures/day).Conclusions: STAR’s modulated insulin and nutrition protocol resulted in better GC performance, and equivalent safety, with far lower workload. It also delivered significantly higher nutrition on the first 2 days of ICU stay, where median time on GC is 2.2 days and STAR had 55% less unfed hours than STAR-IO.