This open loop method, which involves human intervention at three critical points, is prone to human error, decreases nursing efficiency, and does not lead to safe and effective glucose control. In a prospective ICU study comparing Glucommander’s open loop insulin dosing software to a paper based protocol, there was no difference noted in percent time in the desired control range. In addition, the Glucommander group had a higher percent time below the target range and required more frequent adjustments of the intravenous infusion of insulin, which increased the nursing workload. The open loop method of glucose control can take up to 2 hours per patient per day to implement. Closed loop systems do not require any nursing intervention, other than what is required to initiate the system (e.g., start it), and what is required to maintain it on a daily basis. The FUSION system will require no more than 20 minutes to start, and no more than 20 minutes to maintain on a daily basis. A schematic of how the FUSION system works is noted below.
One major advantage the FUSION system has is that it requires no ongoing input from the nurse once it has been started. Because the FUSION system is capable of quickly adapting to changing patient conditions, it does not need to know about things such as meals, changing intravenous fluid/enteral feed rates, NPO orders, or medications/conditions that alter the patient’s insulin sensitivity profile.