Lack of agreement between arterial and central venous blood glucose measurement in critically ill children

Nayak, P.P.; Morris, Kevin; Lang, Hans; Laker, Simon; Stickley, John; Davies, Paul; Barrett, Timothy; Gao, Fang; Gough, Stephen; Narendran, Parth

doi:10.1007/s00134-008-1282-6

Cited by 13 publications

(7 citation statements)

References 4 publications

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“…Some data indicate that there is a lack of agreement between arterial and venous blood glucose measurements in PICU setting [ 20 ], suggesting that sampling site could play a significant role in CGM calibration and insulin therapy. To address this issue we performed a selective analysis of our data pairs from arterial, venous and capillary blood samples.…”

Section: Discussionmentioning

confidence: 99%

Effects of pH, lactate, hematocrit and potassium level on the accuracy of continuous glucose monitoring (CGM) in pediatric intensive care unit

Marics

Koncz²,

Eitler

et al. 2015

Ital J Pediatr

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BackgroundContinuous glucose monitoring (CGM) originally was developed for diabetic patients and it may be a useful tool for monitoring glucose changes in pediatric intensive care unit (PICU). Its use is, however, limited by the lack of sufficient data on its reliability at insufficient peripheral perfusion. We aimed to correlate the accuracy of CGM with laboratory markers relevant to disturbed tissue perfusion.Patients and MethodsIn 38 pediatric patients (age range, 0–18 years) requiring intensive care we tested the effect of pH, lactate, hematocrit and serum potassium on the difference between CGM and meter glucose measurements. Guardian® (Medtronic®) CGM results were compared to GEM 3000 (Instrumentation laboratory®) and point-of-care measurements. The clinical accuracy of CGM was evaluated by Clarke Error Grid -, Bland-Altman analysis and Pearson’s correlation. We used Friedman test for statistical analysis (statistical significance was established as a p < 0.05).ResultsCGM values exhibited a considerable variability without any correlation with the examined laboratory parameters. Clarke, Bland-Altman analysis and Pearson’s correlation coefficient demonstrated a good clinical accuracy of CGM (zone A and B = 96%; the mean difference between reference and CGM glucose was 1,3 mg/dL, 48 from the 780 calibration pairs overrunning the 2 standard deviation; Pearson’s correlation coefficient: 0.83).ConclusionsThe accuracy of CGM measurements is independent of laboratory parameters relevant to tissue hypoperfusion. CGM may prove a reliable tool for continuous monitoring of glucose changes in PICUs, not much influenced by tissue perfusion, but still not appropriate for being the base for clinical decisions.

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Section: Discussionmentioning

confidence: 99%

Effects of pH, lactate, hematocrit and potassium level on the accuracy of continuous glucose monitoring (CGM) in pediatric intensive care unit

Marics

Koncz²,

Eitler

et al. 2015

Ital J Pediatr

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“…These differences directly impact the calculation of point accuracy with a glucose monitoring device. 73-80…”

Section: Discussionmentioning

confidence: 99%

Multicenter Observational Study of the First-Generation Intravenous Blood Glucose Monitoring System in Hospitalized Patients

Bochicchio

Hipszer

Magee

et al. 2015

J Diabetes Sci Technol

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Background: Current methods of blood glucose (BG) monitoring and insulin delivery are labor intensive and commonly fail to achieve the desired level of BG control. There is great clinical need in the hospital for a user-friendly bedside device that can automatically monitor the concentration of BG safely, accurately, frequently, and reliably. Methods: A 100-patient observation study was conducted at 6 US hospitals to evaluate the first generation of the Intravenous Blood Glucose (IVBG) System (Edwards Lifesciences LLC & Dexcom Inc). Device safety, accuracy, and reliability were assessed. A research nurse sampled blood from a vascular catheter every 4 hours for ≤ 72 hours and BG concentration was measured using the YSI 2300 STAT Plus Analyzer (YSI Life Sciences). The IVBG measurements were compared to YSI measurements to calculate point accuracy. Results: The IVBG systems logged more than 5500 hours of operation in 100 critical care patients without causing infection or inflammation of a vein. A total of 44135 IVBG measurements were performed in 100 patients with 30231 measurements from the subset of 75 patients used for accuracy analysis. In all, 996 IVBG measurements were time-matched with reference YSI measurements. These pairs had a mean absolute difference (MAD) of 11.61 mg/dl, a mean absolute relative difference (MARD) of 8.23%, 93% met 15/20% accuracy defined by International Organization for Standardization 15197:2003 standard, and 93.2% were in zone A of the Clarke error grid. The IVBG sensors were exposed to more than 200 different medications with no observable effect on accuracy. Conclusions: The IVBG system is an automated and user-friendly glucose monitoring system that provides accurate and frequent BG measurements with great potential to improve the safety and efficacy of insulin therapy and BG control in the hospital, potentially leading to improved clinical outcomes.

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“…49 The most accurate and precise BG measurements in the hospital are obtained using blood sampled from a radial artery catheter that is assayed with a central laboratory glucose analyzer or an ICU blood gas analyzer. [51][52][53][54] Whole blood samples obtained from a central venous catheter or a peripheral venous catheter may be contaminated or diluted by adjacent infusions. 55 The glucose concentration in peripheral arterial blood is typically 4 to 8 mg/dl higher than peripheral venous blood.…”

Section: Current Methods For Monitoring Bg In the Hospitalmentioning

confidence: 99%

Vascular Glucose Sensor Symposium

Joseph

Torjman

Strasma

2015

J Diabetes Sci Technol

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Hyperglycemia, hypoglycemia, and glycemic variability have been associated with increased morbidity, mortality, length of stay, and cost in a variety of critical care and non-critical care patient populations in the hospital. The results from prospective randomized clinical trials designed to determine the risks and benefits of intensive insulin therapy and tight glycemic control have been confusing; and at times conflicting. The limitations of point-of-care blood glucose (BG) monitoring in the hospital highlight the great clinical need for an automated real-time continuous glucose monitoring system (CGMS) that can accurately measure the concentration of glucose every few minutes. Automation and standardization of the glucose measurement process have the potential to significantly improve BG control, clinical outcome, safety and cost.

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Lack of agreement between arterial and central venous blood glucose measurement in critically ill children

Cited by 13 publications

References 4 publications

Effects of pH, lactate, hematocrit and potassium level on the accuracy of continuous glucose monitoring (CGM) in pediatric intensive care unit

Effects of pH, lactate, hematocrit and potassium level on the accuracy of continuous glucose monitoring (CGM) in pediatric intensive care unit

Multicenter Observational Study of the First-Generation Intravenous Blood Glucose Monitoring System in Hospitalized Patients

Vascular Glucose Sensor Symposium

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