Stochastic Targeted Glycemic Control in the Intensive Care Unit Pilot Trials

Critically ill patients often experience stress-induced hyperglycaemia (high blood sugar levels) and insulin resistance, resulting in increased infection, cardiac events and death. The Christchurch ICU currently controls glucose levels using a system called SPRINT, a paper-based protocol that has provided world leading control and reduced mortality 25-40% in patients who stay 3 days or longer in the ICU. It has also reduced costs by over $1000 per patient treated. However, SPRINT does not allow clinicians to make changes or provide more patient-specific care, when necessary. STAR is a system that uses an algorithm and computer model to provide equivalent or tighter control of glucose levels with greater clinical flexibility and less nursing effort through reduced need for measurements or/and intervention. It also improves safety from low glucose levels (hypoglycaemia) using a statistical model to provide a guaranteed risk of hypoglycemia of 0.1%. STAR pilot trials will be supervised by medical personnel and run for as long as a patient requires glycemic control during their ICU stay. Target glycemic levels will be chosen by the clinical staff. The algorithm will determine all insulin doses and enteral nutrition given to achieve that target with guaranteed safety from hypoglycemia.