摘要：AbstractContinuous glucose monitoring (CGM) technology offers potential benefits of reduced glycaemic control (GC) related workload in the intensive care unit (ICU). Widespread uptake of the technology for care of the critically ill has so far not been achieved, mainly due to the higher drift and point accuracy errors of CGM devices over traditional intermittent blood glucose (BG) measures. This study aims to determine the trade-off between safety, performance and workload that CGM sensors provide in GC protocols. Clinical data from 236 patients were used for clinically validated virtual trials. A CGM-enabled version of the Stochastic TARgeted (STAR) GC protocol was used to evaluate the use of guard rails. Safety was assessed through percentage of patients who had a severe hypoglycaemic episode (BG < 2.2 mmol/L) as well as percentage of resampled BG < 4.0 mmol/L. Performance was assessed as percentage of resampled measurements in the 4.4-7.0 mmol/L and the 4.4-8.0 mmol/L target bands. Workload was measured by number of manual BG measures per day. The CGM-enabled version of STAR maintained performance (76.6% BG measurements in the 4.4-7.0 mmol/L range vs. 62.8% clinically, 87.9% in the 4.4-8.0 mmol/L range vs. 83.7% clinically) with only a slight decrease in patient safety (1.13% of patients experienced a severe hypoglycaemic event vs. 0.85% clinically, 1.37% of BG measurements were less than 4.0 mmol/L vs. 0.51% clinically), while decreasing the number of required blood draws by up to 74%. Existing GC protocols such as STAR may only need to be adjusted slightly to gain the benefits of the increased temporal measurements of CGM sensors, through which workload may be significantly decreased while maintaining GC performance, with only slight decreases in patient safety.
关键词：KeywordsCritical caredisease controlbiologicalmedical system modelling
