Intravascular Microdialysis as a Method for Measuring Glucose and Lactate during and after Cardiac Surgery

Abstract

Background: The aim was to evaluate intravascular microdialysis as a method for measuring blood glucose and lactate in a clinical setting during and after cardiac surgery. Methods: Ten patients undergoing cardiac surgery were included. A microdialysis catheter was percutaneously placed in the superior vena cava or right atrium. Glucose and lactate values measured by the microdialysis technique were analyzed and compared with reference methods, i.e., arterial and venous blood gas values, once every hour up to 24 hours postoperatively. Laboratory plasma glucose was additionally analyzed every 4 hours for reference value. Results: Mean absolute differences were low between microdialysis and reference methods for both glucose and lactate values. All microdialysis glucose values were in the clinically acceptable zone of error grid analysis when compared with plasma glucose values. Accuracy of glucose values was 92% according to International Organization for Standardization criteria. Conclusions: Intravascular microdialysis is a novel and promising technique for real-time and accurate measurement of glucose and lactate during and after open heart surgery. Development of sensor technology may allow for continuous measurement of blood glucose and lactate using intravascular microdialysis.

Introducing intravascular microdialysis for continuous lactate monitoring in patients undergoing cardiac surgery: a prospective observational study

“…studied the correlation between central venous and arterial lactate values and observed a mean difference of 0.03 mmol/L ( r  = 0.996) [23]. In our previous study, we also found good agreement between arterial and venous blood gas lactate values (mean difference = 0.09 mmol/L, limit of agreement ±0.6 mmol/L and Pearson correlation coefficient = 0.92), further supporting arterial blood gas as a reference method [17]. …”

Continuous on-line glucose measurement by microdialysis in a central vein. A pilot study

“…Although the Clarke-Error grid is developed for point-of-care glucose analysers for diabetic patients [20], it may serve as a risk estimator. Similar results were recently obtained in conjunction with cardiac surgery using a similar intravascular microdialysis catheter but the analyses were not performed using the on-line measurements [21]. …”

Continuous Monitoring of Lactate Using Intravascular Microdialysis in High-Risk Cardiac Surgery: A Prospective Observational Study

“…25 Thus, Möller et al found good agreement between arterial and venous blood gas lactate values (mean difference = 0.09 mmol L -1 , limits of agreement ± 0.6 mmol L -1 , r = 0.92), also supporting arterial blood gases as a reference method. 26 Higher limits of agreement between Lactate cont and Lactate art in our study can be explained by the increased lactate values and variations in lactate postoperatively in highrisk cardiac patients. In addition, as the Eirus TM system reflects the blood lactate concentrations approximately five minutes later compared to blood gases, a slight mismatch between the methods may occur which was observed both in our study and in other investigations.…”