Cellular homeostasis requires permanent energy production and consumption. Adenosine triphosphate (ATP) is the major energy component for the cell. Its synthesis occurs mainly in mitochondria where the oxidative phosphorylations realise the coupling between oxygen consumption and phosphorylation of adenosine diphosphate. The anaerobic production of ATP plays an important role in the intermediary metabolism. The enzymatic complexes of the mitochondrial respiratory chain are energy transducers acting as proton pumps. In cardiomyocytes, the phosphocreatine circuit allows a substrate channelling between mitochondria and myofibrils. This metabolic compartmentation explains the difficulties of studying energetic metabolism in the beating heart and the lack of correlation between cardiac function and the usual energy parameters. Mitochondria are a potential site of action of anaesthetic agents. Lipophilic local anaesthetics impair cellular energy metabolism and mitochondrial ATP production. Such effects could be associated with toxic effects of these molecules. NMR or near-infrared spectroscopy are non invasive techniques for monitoring energetic metabolism in vivo. Clinical applications are developed for analysing brain, muscle or cardiac function in physiological and pathological conditions.
ObjectivesBlood glucose and variability in glucose concentrations has recently emerged as playing a key role in critical care. Hyper- and hypoglycemia are associated with increased mortality of critically ill patients. Because blood glucose (BG) levels can drive treatment decisions, accurate and reliable testing is critical in this setting. To meet this challenge a point-of-care (POC) glucose monitoring system (PXP Abbott Diabetes Care) was implemented in the cardiac surgical and cardiac intensive care unit (ICU) of our hospital in order to increase BG testing, distance advising and quality control. We analysed automatically collected capillary BG obtained in everyday life with our intravenous insulin protocol no only in terms of mean blood glucose concentrations but also of variability (SD).The programThe PXP/QCM3 system is intended for professional use in POC testing and has additional features such as built in security options, patient and quality control data management and data networking capabilities. One hundred and eighty meters were installed since October 2006, beginning with ICUs.ResultsDuring the last 3 years a total of 52 823 BG results from 4861 inpatients in the surgical ICU and 63 900 BG from 3843 from inpatients in cardiac ICU were automatically collected by the system during the last 3 years. Intensive intravenous insulin therapy based on frequently measured BG: 9.7 tests/patient/day during the first year,10.8 the second year and 11.8 the third year increased with % of BG at target while % of hypoglycemia decreased together with SD.Thus, this system gives a precise and exhaustive idea not only of BG concentration but also of variability of blood glucose obtained with our intensive insulin algorithms in ICUs.ConclusionsThe strengths of this POC PXP system include delivery of accurate results while providing precious collected data about management of blood glucose in the intensive care setting. The clinical impact in terms of quality, safety, gain of time by medical team and cost savings with hospital distance hyperglycemia management has now to be assessed by a medico-economic multicenter study.Objectifs, contexteL'hyperglycémie est un état très fréquent au moment d'un évènement cardiovasculaire. Une glycémie élevée et variable dès l'admission et durant le séjour en unité de soins intensifs (USI) est facteur de morbi-mortalité reconnu. Peu de données sont disponibles concernant la mesure et le suivi des résultats glycémiques capillaires (GC) en USI. Un système de biologie délocalisée (PXP Abbott) de mesure des GC a été utilisé pour augmenter le nombre de patients bénéficiant du conseil spécialisé à distance, la sécurité (contrôle qualité, traçabilité) des GC, le suivi et l'archivage des résultats.ProgrammeCe travail concerne les patients hospitalisés au décours d'un événement aigu (pontage coronarien, infarctus) ayant des troubles glycémiques. Un programme utilisant le système PXP/QCM3 permettant la centralisation des résultats de GC au sein d'un établissement a été mis en place en 2006. Cet outi...
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