Accuracy of bedside glucose measurement from three glucometers in critically ill patients*

Hoedemaekers, Cornelia; Gunnewiek, Jacqueline M. T. Klein; Prinsen, Marieke A.; Willems, J. L.; Hoeven, Johannes G. van der

doi:10.1097/ccm.0b013e318186ffe6

Cited by 148 publications

(107 citation statements)

References 11 publications

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“…2 however, the hematocrit range clearly interferes with glycemia results, invalidating point-of-care analysis even with arterial blood in severe anemia. 9,31,44 We agree with hoedemaekers et al 44 that in this situation glycemia is sometimes underestimated, and in our study, the corrective formula provided by Mann et al 31 did not effectively correct underestimation. In severe anemia, a frequent ICU situation associated with blood transfusion recommendations 45 requires alternative glycemia-monitoring methods, primarily better glucometers (ie, gas analyzers or last-generation pOC devices that diminish secondary biases at the hemoglobin range).…”

Section: Acknowledgmentssupporting

confidence: 34%

Arterial Catheter Setup for Glucose Control in Critically Ill Patients: A Randomized Controlled Trial

Torredà

Llano-Serrano

Almirall-Solsona

et al. 2014

American Journal of Critical Care

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Background Use of an arterial catheter to obtain hourly blood samples for intensive insulin therapy monitoring avoids causing patients the discomfort of repeated fingersticks. Returning the clearing volume may decrease procedure-related blood loss by 50% and minimize the risk of anemia. Objectives To compare the feasibility of 2 arterial catheter clearing-volume return setups for hourly blood extractions and to evaluate the related complications and the accuracy of arterial samples in determining glycemia.Methods In an open clinical trial, 90 critical patients undergoing intensive insulin therapy who had a radial arterial catheter were randomized to an intervention group-nonwaste needleless setup or nonwaste syringe setup and compared with the standard setup (control group). Mechanical and infectious complications related to the arterial catheter were evaluated. Blood glucose measurements at point-of-care glucometer (arterial catheter or fingerstick sample) were compared with laboratory results (venous blood). Results No patient had catheter-related infection in the intervention group (an estimated 12 776 manipulations); the control group had 2 infection episodes in 5230 catheter-days (an estimated 13 075 manipulations). The incidence of bacterial colonization was not significantly higher in the needleless group than in the syringe group (22.2% vs 12.2%; relative risk, 0.55; 95% CI, 0.16-1.71), with 1778 (SD, 114) and 1918 (SD, 82) catheter manipulations, respectively. Arterial catheter complications were negligible in all patients. Glycemia was detected from arterial catheter samples as effectively as with laboratory results (venous samples) except when hematocrit was less than 25%. Conclusions Use of blood obtained via an arterial catheter is safe and effective for glucose monitoring in patients undergoing intensive insulin therapy, with no increase in complications of catheterization.

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Section: Acknowledgmentssupporting

confidence: 34%

Arterial Catheter Setup for Glucose Control in Critically Ill Patients: A Randomized Controlled Trial

Torredà

Llano-Serrano

Almirall-Solsona

et al. 2014

American Journal of Critical Care

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“…Plasma glucose values by capillary point-of-care testing have been found to be potentially inaccurate, with frequent false elevations [479][480][481] over the range of glucose levels, but especially in the hypoglycemic and hyperglycemic ranges [482] and in shock patients (receiving vasopressors) [478,480]. A review of studies found the accuracy of glucose measurements by arterial blood gas analyzers and glucose meters by using arterial blood significantly higher than measurements with glucose meters using capillary blood [480].…”

Section: We Suggest the Use Of Arterial Blood Rather Than Capillary Bmentioning

confidence: 99%

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

et al. 2017

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Objective: To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012". Design:A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. A stand-alone meeting was held for all panel members in December 2015. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. Methods:The panel consisted of five sections: hemodynamics, infection, adjunctive therapies, metabolic, and ventilation. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Each subgroup generated a list of questions, searched for best available evidence, and then followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the quality of evidence from high to very low, and to formulate recommendations as strong or weak, or best practice statement when applicable.

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“…While few animal studies have been done, the reliability of CGMSs in critically ill patients is an area of active research. The results to date have revealed a strong correlation between arterial reference blood glucose and better performance, compared with point-of-care devices (Corstjens et al 2006;Hoedemaekers et al 2008;Holzinger et al 2009;Brunner et al 2011). These studies pointed out that the accuracy of CGMSs becomes diminished in the hypoglycaemic range.…”

Section: Discussionmentioning

confidence: 99%

Comparison of continuous and intermittent glucose monitoring systems in a dog with diabetic ketoacidosis: a case report

Kim¹,

Kim²,

Kang³

et al. 2017

Vet. Med. - Czech

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ABSTRACT:A Miniature schnauzer (12 years old, neutered male) was referred for lethargy, anorexia, and oral bleeding. On initial evaluation, severe hyperglycaemia (blood glucose concentration of 34.9 mmol/l), ketonuria, systemic inflammation (fever, panting, left-shift neutrophilia, and a high C-reactive protein level of 980.97 nmol/l, abnormal pancreatic lipase immunoreactivity, and periodontitis were found. With consideration of possible insulin resistance, blood glucose (BG) levels were monitored using a portable glucose meter (q 1-3 h) and a continuous glucose monitoring system (CGMS) for 72 h (three consecutive trials); intensive insulin therapy was initiated using regular insulin (2.2 IU/kg intravenously). The insulin doses needed, based on the nadir, peak, and duration of insulin action from a traditional intermittent glucose curve were higher than those based on the CGMS results. Meanwhile, transient hyperglycaemic and hypoglycaemic periods, occurring between the intermittent measurements, were easily identified with the CGMS. Therefore, insulin resistance and the Somogyi phenomenon are less likely to occur with use of the CGMS than with intermittent BG measurements. By comparing data from a CGMS to those from an intermittent portable BG measurement system, this case report emphasises the importance and usefulness of a CGMS.

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Accuracy of bedside glucose measurement from three glucometers in critically ill patients*

Cited by 148 publications

References 11 publications

Arterial Catheter Setup for Glucose Control in Critically Ill Patients: A Randomized Controlled Trial

Arterial Catheter Setup for Glucose Control in Critically Ill Patients: A Randomized Controlled Trial

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Comparison of continuous and intermittent glucose monitoring systems in a dog with diabetic ketoacidosis: a case report

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