Analysis of blood glucose measurements using capillary and arterial blood samples in intensive care patients

Kulkarni, Atul P; Saxena, Manoj; Price, Grant; O’Leary, Michael J.; Jacques, Theresa; Myburgh, John

doi:10.1007/s00134-004-2500-5

Cited by 89 publications

(59 citation statements)

References 11 publications

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“…[23][24][25][26] Adults in the intensive care setting with poor perfusion are especially prone to have differing results between bedside capillary glucometry and venous lab glucose tests. 27,29 In addition, venous samples may underestimate hypoglycemia.…”

Section: Recommendation #2mentioning

confidence: 99%

An Evidence-based Guideline for Pediatric Prehospital Seizure Management Using GRADE Methodology

Shah¹,

Macias²,

Dayan³

et al. 2013

Prehospital Emergency Care

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Objective. The objective of this guideline is to recommend evidence-based practices for timely prehospital pediatric seizure cessation while avoiding respiratory depression and seizure recurrence. Methods. A multidisciplinary panel was chosen based on expertise in pediatric emergency medicine, prehospital medicine, and/or evidence-based guideline development. The panel followed the National Prehospital EBG Model using the GRADE methodology to formulate questions, retrieve evidence, appraise the evidence, and formu- The panel finalized a draft of a patient care algorithm in 2012 that was presented to stakeholder organizations to gather feedback for necessary revisions. Results. Five strong and ten weak recommendations emerged from the process; all but one was supported by low or very low quality evidence. The panel sought to ensure that the recommendations promoted timely seizure cessation while avoiding respiratory depression and seizure recurrence. The panel recommended that all patients in an active seizure have capillary blood glucose checked and be treated with intravenous (IV) dextrose or intramuscular (IM) glucagon if <60 mg/dL (3 mmol/L). The panel also recommended that non-IV routes (buccal, IM, or intranasal) of benzodiazepines (0.2 mg/kg) be used as first-line therapy for status epilepticus, rather than the rectal route. Conclusions. Using GRADE methodology, we have developed a pediatric seizure guideline that emphasizes the role of capillary blood glucometry and the use of buccal, IM, or intranasal benzodiazepines over IV or rectal routes. Future research is needed to compare the effectiveness and safety of these medication routes.

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Section: Recommendation #2mentioning

confidence: 99%

An Evidence-based Guideline for Pediatric Prehospital Seizure Management Using GRADE Methodology

Shah¹,

Macias²,

Dayan³

et al. 2013

Prehospital Emergency Care

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“…Blood gas Arora [66] 2011 Prospective USA 516 SN, SP, PPV, NPV Bailey [67] 1998 Prospective USA 222 NR Beneteau Burnat [68] 2004 Experimental France 20 NR Beneteau Burnat [69] 2008 Experimental France NR NR Chance [70] 2000 Experimental USA NR NR Coplin [71] 1998 Prospective USA 195 SN, SP Dohgomori [72] 2004 Prospective Japan 27 NR Frasca [73] 2011 Prospective France 471 NR Gayat [74] 2001 Prospective France 200 NR Gehring [75] 2002 Experimental Germany 450 NR Grosse [76] 2010 Prospective Switzerland NR NR Halpern [77] 1998 Prospective USA NR NR Hinkelbein [78] 2008 Prospective Germany 170 NR Jacobs [79] 1993 Experimental USA 259 NR Jain [80] 2009 Cohort USA 200 NR Kilgore [81] 1998 Prospective USA NR NR Kulkani [82] 2005 Prospective Australia NR NR Leino [83] 2011 RCT Finland 60 NR Lindemans [84] 1999 Experimental Netherlands NR NR Ng [85] 2000 Experimental USA NR NR Papadea [86] 2002 Experimental USA NR NR Petersen [87] 2008 Prospective USA 114 NR Prause [88] 1997 Experimental Austria NR NR Schlebush [89] 2001 Experimental Germany NR NR Sediame [90] 1999 Experimental France 92 NR Steinfelder Visscher [91] 2006 Prospective Netherlands 127 NR Thomas [92] 2009 Cohort USA 446 NR Walton [93] 2003 Experimental USA 59 NR Wax [94] 2007 Retrospective USA NR NR Zaman [95] 2001 experimental Belgium 20 NR LR+, positive likelihood ratio; LR-, negative likelihood ratio; NPV, negative predictive value; NR, not reported; PPV, positive predictive value; PTH, parathyroid hormone SN, sensitivity; SP, specificity.…”

Section: Diagnostic Accuracy Outcomementioning

confidence: 99%

Point-of-care testing: where is the evidence? A systematic survey

Pecoraro

Germagnoli

Banfi

2013

Clinical Chemistry and Laboratory Medicine (CCLM)

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Point-of-care testing (POCT) has had rapid techno logical development and their use is widespread in clinical laboratories to assure reduction of turn-aroundtime and rapid patient management in some clinical settings where it is important to make quick decisions. Until now the papers published about the POCT have focused on the reliability of the technology used and their analy tical accuracy. We aim to perform a systematic survey of the evidence of POCT efficacy focused on clinical outcomes, selecting POCT denoted special analytes characterized by possible high clinical impact. We searched in Medline and Embase. Two independent reviewers assessed the eligibility, extracted study details and assessed the methodological quality of studies. We analyzed 84 studies for five POCT instruments: neonatal bilirubin, procalcitonin, intra-operative parathyroid hormone, troponin and blood gas analysis. Studies were at high risk of bias. Most of the papers (50%) were studies of correlation between the results obtained by using POCT instruments and those obtained by using laboratory instruments. These data showed a satisfactory correlation between methods when similar analytical reactions were used. Only 13% of the studies evaluated the impact of POCT on clinical practice. POCT decreases the time elapsed for making decisions on patient management but the clinical outcomes have never been adequately evaluated. Our work shows that, although POCT has the potential to provide beneficial patient outcome, further studies may be required, especially for defining its real utility on clinical decision making.

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“…Although POC devices for glucose testing are calibrated for use with capillary fingerstick blood, clinicians often obtain blood for POC testing from indwelling arterial or central venous catheters (CVCs). Despite the frequency of this practice, few clinical studies [4][5][6][7][8][9][10] have been done to evaluate the performance of POC glucose devices with blood from indwelling catheters. Several of the studies had serious methodological problems, including small sample size, 4 poorly described methods, 5,9,10 and inappropriate statistical analysis.…”

Section: Instrumentsmentioning

confidence: 99%

“…Despite the frequency of this practice, few clinical studies [4][5][6][7][8][9][10] have been done to evaluate the performance of POC glucose devices with blood from indwelling catheters. Several of the studies had serious methodological problems, including small sample size, 4 poorly described methods, 5,9,10 and inappropriate statistical analysis. 5,6,10 differences occurred between the reference glucose value (laboratory glucose) and the POC glucose values (CVC and fingerstick blood).…”

Section: Instrumentsmentioning

confidence: 99%

“…Confounding factors identified in earlier studies include pH, shocklike states, hypoxemia, hematocrit level, vasopressor use, and peripheral edema. 5,7,9,10,19,20,22,[28][29][30][31][32][33][34] Hoping to use the results of our study to affect the way POC testing is done in our unit, we selected 2 of these variables to evaluate, because POC testing finger edema: the limited number of high scores for edema in our study (<25% of patients had scores of 3+ or 4+), poor interrater reliability in scoring of edema, and a lack of effect of edema on POC and laboratory differences.…”

Section: Effect Of Hematocrit and Peripheral Edemamentioning

confidence: 99%

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Differences in Glucose Values Obtained From Point-of-Care Glucose Meters and Laboratory Analysis in Critically Ill Patients

Cook

Laughlin

Moore

et al. 2009

American Journal of Critical Care

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Background Blood for glucose analysis is often obtained interchangeably from indwelling catheters and fingersticks. Objectives To determine the level of agreement between glucose values obtained by laboratory analysis and with a pointof-care device for blood from 2 different sources: fingerstick and a central venous catheter. Methods A method-comparison design was used. Point-of-care values for blood from fingersticks and catheters were compared with laboratory values for blood from catheters in a convenience sample of 67 critically ill patients. The effects of hematocrit level and finger edema on differences in glucose values between the 2 methods were also evaluated. A t test was used to determine differences in glucose values obtained via the 2 methods. Differences and limits of agreement were also calculated. Results Laboratory glucose values for blood from a catheter differed significantly from point-of-care values for blood from the catheter (t 1,66 = -9.18; P < .001) and from a fingerstick (t 1,66 = 6.53; P < .001). Glucose values for the 2 methods differed by 20 mg/dL or more for 1 of 6 patients (15%) for catheter samples and for 1 of 5 (21%) for fingerstick samples. Point-of-care glucose values for fingerstick and catheter samples did not differ (P = .98). Hematocrit level significantly explained the difference in glucose values between the 2 methods for both catheter (R 2 = 0.288; P < .001) and fingerstick (R 2 = 0.280; P = .02) samples. Conclusions Notice to CE enrollees:A closed-book, multiple-choice examination following this article tests your under standing of the following objectives: 1. Describe the relationship of euglycemic glucose levels to outcomes for critically ill patients. 2. Understand the importance of differences between point-of-care (POC) glucose testing and laboratory glucose testing used with critically ill patients. 3. Recognize the relationship between hemoglobin levels and the accuracy of POC test values for blood glucose.

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Analysis of blood glucose measurements using capillary and arterial blood samples in intensive care patients

Cited by 89 publications

References 11 publications

An Evidence-based Guideline for Pediatric Prehospital Seizure Management Using GRADE Methodology

An Evidence-based Guideline for Pediatric Prehospital Seizure Management Using GRADE Methodology

Point-of-care testing: where is the evidence? A systematic survey

Differences in Glucose Values Obtained From Point-of-Care Glucose Meters and Laboratory Analysis in Critically Ill Patients

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