BACKGROUND: Hyperglycemia is prevalent in critical care, and tight control can significantly reduce mortality. However, current protocols have been considered taxing to administer and may require extra staff. In addition, increased insulin resistance and saturation effects limit the level of control possible using insulin alone. Thus, regulating both insulin and exogenous nutritional inputs is required to control blood glucose. METHODS: A robust, easy-to-use protocol ["SPRINT" (Specialized Relative Insulin Nutrition Tables)] that employs both insulin and feed modulation is developed and analyzed using retrospective data from 19 patients with average Acute Physiology and Chronic Health Evaluation II score of 21.8. Results are compared with several published protocols in simulation, and verified in a proof-of-concept trial. RESULTS: In simulation, 61.7% of measurements were in the 75-110 mg/dL band and 83.5% in the 75-140 mg/dL band. Results from the simulation of published protocols agreed with published results. Clinically, for two patients, 64% and 85% of measurements were between 75 and 110 mg/dL during the two proof-of-concept trials. Total enteral feeding was similar to, or exceeded, retrospective data. CONCLUSIONS: Tight control was achieved in simulation using a protocol that is easy to implement in an intensive care unit. Similarly tight control was also maintained during the two proof-of-concept clinical trials. Measurement frequency of 1-2 h is seen to be critical to achieving and maintaining tight control. The overall SPRINT protocol is easy to use for clinical staff and effective in achieving and maintaining normoglycemia in critical illness.
BACKGROUND:Hyperglycemia is prevalent in critical care, and tight control can significantly reduce mortality. However, current protocols have been considered taxing to administer and may require extra staff. In addition, increased insulin resistance and saturation effects limit the level of control possible using insulin alone. Thus, regulating both insulin and exogenous nutritional inputs is required to control blood glucose. METHODS: A robust, easy-to-use protocol ["SPRINT" (Specialized Relative Insulin Nutrition Tables)] that employs both insulin and feed modulation is developed and analyzed using retrospective data from 19 patients with average Acute Physiology and Chronic Health Evaluation II score of 21.8. Results are compared with several published protocols in simulation, and verified in a proof-of-concept trial. RESULTS: In simulation, 61.7% of measurements were in the 75-110 mg/dL band and 83.5% in the 75-140 mg/dL band. Results from the simulation of published protocols agreed with published results. Clinically, for two patients, 64% and 85% of measurements were between 75 and 110 mg/dL during the two proof-of-concept trials. Total enteral feeding was similar to, or exceeded, retrospective data. CONCLUSIONS: Tight control was achieved in simulation using a protocol that is easy to implement in an intensive care unit. Similarly tight control was also maintained during the two proof-of-concept clinical trials. Measurement frequency of 1-2 h is seen to be critical to achieving and maintaining tight control. The overall SPRINT protocol is easy to use for clinical staff and effective in achieving and maintaining normoglycemia in critical illness.
Authors: Alicia Evans; Aaron Le Compte; Chia-Siong Tan; Logan Ward; James Steel; Christopher G Pretty; Sophie Penning; Fatanah Suhaimi; Geoffrey M Shaw; Thomas Desaive; J Geoffrey Chase Journal: J Diabetes Sci Technol Date: 2012-01-01
Authors: J Geoffrey Chase; Christopher G Pretty; Leesa Pfeifer; Geoffrey M Shaw; Jean-Charles Preiser; Aaron J Le Compte; Jessica Lin; Darren Hewett; Katherine T Moorhead; Thomas Desaive Journal: Crit Care Date: 2010-08-12 Impact factor: 9.097
Authors: Saeid Eslami; Ameen Abu-Hanna; Nicolette F de Keizer; Rob J Bosman; Peter E Spronk; Evert de Jonge; Marcus J Schultz Journal: Intensive Care Med Date: 2010-06-09 Impact factor: 17.440
Authors: J Geoffrey Chase; Aaron LeCompte; Geoffrey M Shaw; Amy Blakemore; Jason Wong; Jessica Lin; Christopher E Hann Journal: J Diabetes Sci Technol Date: 2008-07
Authors: Christopher E Hann; J Geoffrey Chase; Michael F Ypma; Jos Elfring; Noorhafiz Mohd Nor; Piers Lawrence; Geoffrey M Shaw Journal: Open Med Inform J Date: 2008-05-27