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Open Access Research article

Glucose control in intensive care: usability, efficacy and safety of Space GlucoseControl in two medical European intensive care units

Karin Amrein1*, Norman Kachel2, Heike Fries2, Roman Hovorka3, Thomas R Pieber14, Johannes Plank1, Urs Wenger5, Barbara Lienhardt5 and Marco Maggiorini5

Author Affiliations

1 Medical University of Graz, Austria, Department of Internal Medicine, Division of Endocrinology and Metabolism, Auenbruggerplatz 15, 8036 Graz, Austria

2 BBraun, Melsungen, Germany

3 Institute of Metabolic Science, University of Cambridge, Cambridge, UK

4 Joanneum Research Forschungsgesellschaft mbH, Graz, Austria

5 Medical University of Zurich, Department of Internal Medicine, Medical Intensive Care Unit, Zurich, Switzerland

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BMC Endocrine Disorders 2014, 14:62  doi:10.1186/1472-6823-14-62

Published: 29 July 2014

Abstract

Background

The Space GlucoseControl system (SGC) is a nurse-driven, computer-assisted device for glycemic control combining infusion pumps with the enhanced Model Predictive Control algorithm (B. Braun, Melsungen, Germany). We aimed to investigate the performance of the SGC in medical critically ill patients.

Methods

Two open clinical investigations in tertiary centers in Graz, Austria and Zurich, Switzerland were performed. Efficacy was assessed by percentage of time within the target range (4.4-8.3 mmol/L; primary end point), mean blood glucose, and sampling interval. Safety was assessed by the number of hypoglycemic episodes (≤2.2 mmol/L) and the percentage of time spent below this cutoff level. Usability was analyzed with a standardized questionnaire given to involved nursing staff after the trial.

Results

Forty medical critically ill patients (age, 62 ± 15 years; body mass index, 30.0 ± 8.9 kg/m2; APACHE II score, 24.8 ± 5.4; 27 males; 8 with diabetes) were included for a period of 6.5 ± 3.7 days (n = 20 in each center). The primary endpoint (time in target range 4.4 to 8.3 mmol/l) was reached in 88.3% ± 9.3 of the time and mean arterial blood glucose was 6.7 ± 0.4 mmol/l. The sampling interval was 2.2 ± 0.4 hours. The mean daily insulin dose was 87.2 ± 64.6 IU. The adherence to the given insulin dose advice was high (98.2%). While the percentage of time spent in a moderately hypoglycemic range (2.2 to 3.3 mmol/L) was low (0.07 ± 0.26% of the time), one severe hypoglycemic episode (<2.2 mmol/L) occurred (2.5% of patients or 0.03% of glucose readings).

Conclusions

SGC is a safe and efficient method to control blood glucose in critically ill patients as assessed in two European medical intensive care units.

Keywords:
Tight glycemic control; Critical illness; Critically ill patients; Protocol; Computer-assisted glycemic control; Insulin infusion protocol; Glucose control in intensive care