Can the STAR protocol generalize
effectively? Initial clinical results in New
Zealand and Hungarian ICUs
Balazs Benyo1, PhD; Attila Illyés2, MD, PhD; Attila Havas2, MD, PhD; Noémi Szabó
Némedi2, MD, PhD; Aaron J. Le Compte3, PhD; Liam Fisk3, BE(Hons); Geoffrey M.
Shaw4, MBChB; J. Geoffrey Chase3, PhD
1: Medical Informatics, Budapest Univ of Technology and Economics, Hungary
bbenyo@iit.bme.hu
2: Dept of Anesthesiology and Intensive Care, Kálmán Pándy Hospital, Gyula, Hungary
3: Univ of Canterbury, Dept of Mechanical Eng, Christchurch, New Zealand
4: Dept of Intensive Care, Christchurch Hospital, Christchurch, New Zealand
Objective:
To report initial clinical results of the STAR glycemic control protocol at an independent intensive care
unit (ICU) in comparison to its first implementation.
Method:
15 pilot episodes (1168hours) using the STAR (Stochastic TARgeted) at Kálmán Pándy Hospital (Gyula,
Hungary) are compared to 38 episodes (3763hours) in Christchurch Hospital. Gyula administers insulin as
a constant infusion and Christchurch as boluses. Nutrition was controlled by STAR. Measurements were 13-hourly per protocol. Performance is assessed by percentage of (hourly resampled) BG measurements in
glycemic bands for the cohort. Safety by numbers of patients with BG < 2.2mmol/L (severe) and
percentage BG<4.0mmol/L. Clinical effort is assessed by measurements per day.
Results:
Effort was similar, with 12.8 and 12.4 measurements/day in Gyula and Christchurch. For performance:
Gyula: Cohort BG was 6.6 [5.6-7.7]mmol/L with 72.7% and 80.43% of BG in the 4.4-7.0 and 4.4-8.0
mol/L bands, respectively. Gyula: Cohort BG was 6.0 [5.4-6.8]mmol/L with 72.7% and 80.43% of BG in
the 4.4-7.0 and 4.4-8.0 mol/L bands with 2.2% BG<4.0mmol/L. Christchurch: Cohort BG was 6.1 [5.66.8]mmol/L with 77.8% and 89.43% of BG in the 4.4-7.0 and 4.4-8.0 mol/L bands with 0.87%
BG<4.0mmol/L. There were no severe hypoglycemic events Performance differences were due to 1 patient
in Gyula. Insulin dosing was similar: 2.5 [1.0-4.5]U/hour and 3.0 [1.5-4.5]U/hour for Gyula and
Christchurch.
Conclusion:
STAR was equally effective in an independent ICU across geographically distinct clinical units, patients,
and clinical practice. No significant difference was seen between using constant infusion or bolus insulin
delivery. Overall, the STAR framework was readily transposed and very good glycemic control achieved.