Accuracy of Glycemic Measurements in the Critically Ill

Slater-MacLean, Linda; Cembrowski, George; Chin, Dat; Shalapay, Carol E.; Binette, Tanya M.; Hegadoren, Kathy; Newburn‐Cook, Christine

doi:10.1089/dia.2008.0263

Cited by 44 publications

(49 citation statements)

References 14 publications

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“…Differences between the 2 groups were found only when we included arterial samples in the analysis (as in the previous studies). This finding could have important implications in treating critically ill patients because it supports studies such as those by Scott et al, 32 Lacara et al, 33 and Slater-MacLean et al, 34 who found that capillary blood glucose values were higher than the corresponding arterial blood glucose values, and NICE-SUGAR, 17 which recommended against use of fingerstick samples for analysis of blood glucose levels.…”

Section: Resultssupporting

confidence: 72%

Hypoglycemic Events in Intensive Care Patients: Analysis by Insulin Administration Method and Sample Type

Torredà

Pérez²,

Aragón³

et al. 2011

American Journal of Critical Care

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Background Intensive insulin treatment is associated with an increased risk of hypoglycemia, so strict glycemic monitoring is essential. The best type of sample for identifying hypoglycemia remains under debate. Objectives To establish the number of hypoglycemic events in intensive care patients relative to insulin administration method and the method used to collect the blood sample. Methods Retrospective descriptive study lasting 6 months. Hypoglycemia was defined as a blood glucose level less than 80 mg/dL (mild: 50-79 mg/dL, severe: <50 mg/dL), measured with a bedside glucometer and blood from the arterial catheter or fingerstick, in critically ill patients who require insulin administered subcutaneously (with sliding scales) or via continuous intravenous perfusion (intense infusion protocol with a nurse-managed insulin therapy algorithm). Results Analysis of the 6636 samples from 144 critically ill patients revealed 188 mildly hypoglycemic samples (2.8%) and 3 severely hypoglycemic samples (0.04%). The prevalence of mild hypoglycemia was greater when insulin was administered intravenously (3.2%) rather than subcutaneously (2.3%; P = .04). Among patients receiving insulin intravenously, hypoglycemia was found more often in arterial (4.5%) than in capillary (2.8%) blood (P = .01). The prevalence of hypoglycemia in capillary blood samples did not differ significantly between subcutaneous (2.3%) and intravenous (2.8%) insulin therapies (P = .21). Conclusions With a target blood glucose level of 110 to 140 mg/dL, few hypoglycemic events are detected in critically ill patients, regardless of whether insulin is administered intravenously or subcutaneously. Analysis of solely arterial samples may yield a higher prevalence of hypoglycemia than otherwise.

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Section: Resultssupporting

confidence: 72%

Hypoglycemic Events in Intensive Care Patients: Analysis by Insulin Administration Method and Sample Type

Torredà

Pérez²,

Aragón³

et al. 2011

American Journal of Critical Care

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“…In contrast, another investigator found that clinically significant differences existed in device performance for this patient population. Nevertheless, almost all glucose meter results fell within acceptable zones on a conventional consensus error grid (14 ). Such data would suggest that error grid analysis may not be optimal for evaluating devices used in critically ill populations.…”

Section: Discussionmentioning

confidence: 91%

“…Several studies have directly examined glucose meter performance when these devices are used to manage patients on tight glycemic control (8,(11)(12)(13)(14); however, interpretation of these studies has been confounded by the different approaches used to assess glucose meter accuracy. Clinical outcome studies relating meter accuracy to patient outcome during TGC would be ideal, although they require large numbers of patients and are resource intensive.…”

confidence: 99%

Glucose Meter Performance Criteria for Tight Glycemic Control Estimated by Simulation Modeling

2010

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“…2 Fingersticks, which can be painful for the patient, may yield unreliable glycemic values when a point-of-care (pOC) glucometer with capillary sampling is used. [3][4][5][6] Although the pOC glucometer is of particular concern in patients with anemia, [7][8][9] it has been used in numerous studies. 10 In critically ill patients, pressure-monitoring systems connected to indwelling arterial catheters also allow repeated extraction of blood samples.…”

Section: Intervention Groupmentioning

confidence: 99%

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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Accuracy of Glycemic Measurements in the Critically Ill

Cited by 44 publications

References 14 publications

Hypoglycemic Events in Intensive Care Patients: Analysis by Insulin Administration Method and Sample Type

Hypoglycemic Events in Intensive Care Patients: Analysis by Insulin Administration Method and Sample Type

Glucose Meter Performance Criteria for Tight Glycemic Control Estimated by Simulation Modeling

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

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