Prospective detection of hyperglycemia in critically ill children using continuous glucose monitoring*

Allen, Holley; Rake, Alyssa; Roy, Marybeth; Brenner, Dennis; McKiernan, Christine

doi:10.1097/pcc.0b013e3181668b33

Cited by 20 publications

(22 citation statements)

References 24 publications

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“…Egy osztályunkon ápolt, congenitalis centrális hypoventilatióban szenvedő újszülöttnél alkalmazott CGM rendkívül érzékenynek bizonyult a hyperinsulinaemia okozta hypoglykaemiák felderítésében [37]. Allen és mtsai 20, intenzív ellátásra szoruló gyermek betegben igazolták a CGM hasznosságát a hyperglykaemiák pontosabb felderítésében [38]. Joggal merülhet fel a kérdés, hogy a szubkután szövet-ben történő mérés mennyire megbízható olyan betegek esetében, akiknek kritikus állapota befolyással lehet a szöveti perfúzióra.…”

Section: Cgm Az Intenzív Osztályonunclassified

Role of continuous subcutaneous glucose monitoring in intensive care

et al. 2013

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A kritikus állapotú betegek stressz-hyperglykaemiájának értékelése az elmúlt évtizedben jelentősen megváltozott. A vércukor szoros kontrolljának mortalitást csökkentő hatását igazolta több jelentős vizsgálat, ugyanakkor az ezt célzó inzulinkezelés megnöveli a hypoglykaemia kockázatát, amely független mortalitási tényező lehet. A hypoglykaemia szempontjából kiemelt jelentőségű a gyermekpopuláció, a fejlődő idegrendszer miatt. Ezek alapján joggal merül fel a vércukorváltozások intenzív osztályos monitorizálásának igénye, különösen gyermek betegeknél. A hagyományos, vérmintából történő vércukor-meghatározások nem tesznek lehetővé kellően szoros monitorizálást. A cukorbetegek számára kifejlesztett, a szövet közti glükóz meghatározásán alapuló módszerek (continuous glucose monitoring) jó alternatívát jelenthetnek az intenzív osztályos monitorizálásra, amennyiben felmérjük a rendszer korlátait. A mérés a szövet közti folyadékban történik, így a szöveti perfúzió változásai zavarhatják a pontosságát. A folyamatos glükózmonitoring módszer intenzív osztályos alkalmazását jelenleg még nem javasolják, amíg a rendszer megbízhatóságáról nem áll rendelkezésre elegendő adat. Összefoglaló közleményükben a szerzők a magyar klinikai gyakorlatban elterjedt Medtronic folyamatos szubkután glükózmonitorizáló rendszert értékelik, részben saját eredményeik alapján. Orv. Hetil., 2013, 154, 1043-1048 Kulcsszavak: intenzív terápia, hyperglykaemia, hypoglykaemia, szöveti glükóz monitorizálása, CGM Role of continuous subcutaneous glucose monitoring in intensive careCritical care associated with stress hyperglycaemia has gained a new view in the last decade since the demonstration of the benefi cial effects of strong glycaemic control on the mortality in intensive care units. Strong glycaemic control may, however, induce hypoglycaemia, resulting in increased mortality, too. Pediatric population has an increased risk of hypoglycaemia because of the developing central nervous system. In this view there is a strong need for close monitoring of glucose levels in intensive care units. The subcutaneous continuous glucose monitoring developed for diabetes care is an alternative for this purpose instead of regular blood glucose measurements. It is important to know the limitations of subcutaneous continuous glucose monitoring in intensive care. Decreased tissue perfusion may disturb the results of subcutaneous continuous glucose monitoring, because the measurement occurs in interstitial fl uid. The routine use of subcutaneous continuous glucose monitoring in intensive care units is not recommended yet until suffi cient data on the reliability of the system are available. The Medtronic subcutaneous continuous glucose monitoring system is evaluated in the review partly based on the authors own results. Orv. Hetil., 2013, 154, 1043-1048. Ennek kialakulásában szerepet játszanak a stressz hatá-sára létrejövő hormonális és celluláris változások. Szív-

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Section: Cgm Az Intenzív Osztályonunclassified

Role of continuous subcutaneous glucose monitoring in intensive care

et al. 2013

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“…They have also been studied in small groups of children in the PICU and have shown that intermittent glucose measurement can miss significant episodes of hyperglycemia (20). Their role in routine measurement of glucose in the PICU is still unclear.…”

Section: Discussionmentioning

confidence: 99%

Comparison of bedside and laboratory blood glucose estimations in critically ill children with shock

Ramachandran

Sethuraman²,

Ravikumar³

et al. 2011

Pediatric Critical Care Medicine

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“…The pinpoint of our study was not to ascertain the accuracy of current CGMS -we consider this question as being already solved by larger studies mentioned above [33][34][35][36][37][38][39][40][41] . We focused on glycaemia trends of operated patients, on identification of frequent patterns of glycaemic reaction to stress and on the determination of eventual CGM impact on glycaemic stability in individual cases.…”

Section: Hunger After the Surgerymentioning

confidence: 99%

“…Goldberg used them in a medical ICU in 2004 and found 98.7% of the paired values clinically acceptable; he evaluated CGM as a reducer of glycaemia fluctuations and a promising research tool 34 . Others found it useful for reducing hyperglycaemic episodes 35 . The analysis of two prospective randomized trials demonstrated clinically sufficient accuracy and safety 36,37 even in patients on vasopressors 38 .…”

Section: Introductionmentioning

confidence: 99%

Glucose sensing module - is it time to integrate it into real-time perioperative monitoring? An observational pilot study with subcutaneous sensors

Poljakova¹,

Elsikova²,

Chlup³

et al. 2013

BIOMED PAP

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Aims.To explore the feasibility of subcutaneous continuous glucose monitoring (CGM) in perioperative settings and to evaluate the perioperative development of glycaemia in persons with diabetes mellitus or impaired glucose tolerance by means of CGM. Methods. Monitoring by means of Guardian® REAL-Time CGMS (Medtronic, Nortridge, USA) in 20 perioperative periods. Sensor was inserted on the day before surgery and continued for 3 days with some exceptions. Results. Full implementation of the method was successful in the intensive care unit setting only. No electromagnetic interference and no side effects were found. The Wilcoxon signed-rank test revealed no significant difference between sensor and laboratory analyser values. Pearson´s correlation coefficients of the values obtained by sensor and the Wellion Linus glucometer were 0.875 for the whole perioperative period, 0.866 for the intraoperative period and 0.903 for the first perioperative day. A decline in sensor accuracy on the 6 th day was registered in one case. 16 monitored cases (80%) did not meet the criteria for safe plasma glucose range. Hypoglycaemia was found in 4 (20%) cases. There was an association between grade of the perioperative dysglycaemia and need for reoperation within the next 3 months. The most frequent perioperative glycaemic patterns are demonstrated. Conclusion. Subcutaneous CGM is safe offering detailed insight into glucose homeostasis in the dynamic perioperative period. Laboratory confirmation of sensor plasma glucose concentration by approved laboratory analyser is still necessary. The potentional benefits of maintaining patients within a safe glucose range should be comfirmed by future studies.

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Prospective detection of hyperglycemia in critically ill children using continuous glucose monitoring*

Abstract: Significant hyperglycemia is present in pediatric intensive care patients and may be underestimated by intermittent laboratory monitoring.

Cited by 20 publications

References 24 publications

Role of continuous subcutaneous glucose monitoring in intensive care

Role of continuous subcutaneous glucose monitoring in intensive care

Comparison of bedside and laboratory blood glucose estimations in critically ill children with shock

Glucose sensing module - is it time to integrate it into real-time perioperative monitoring? An observational pilot study with subcutaneous sensors

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