Abstract
We evaluated a standard subcutaneous microdialysis technique for glucose monitoring in two critically ill patient populations and tested whether a prolonged run-in period improves the quality of the interstitial glucose signal. 20 surgical patients after major cardiac surgery (APACHE II score: 10.1 ± 3.2) and 10 medical patients with severe sepsis (APACHE II score: 31.1 ± 4.3) were included in this investigation. A microdialysis catheter was inserted in the subcutaneous adipose tissue of the abdominal region. Interstitial fluid and arterial blood were sampled in hourly intervals to analyse glucose concentrations. Subcutaneous adipose tissue glucose was prospectively calibrated to reference arterial blood either at hour 1 or at hour 6. Median absolute relative difference of glucose (MARD), calibrated at hour 6 (6.2 (2.6; 12.4) %) versus hour 1 (9.9 (4.2; 17.9) %) after catheter insertion indicated a significant improvement in signal quality in patients after major cardiac surgery (p < 0.001). Prolonged run-in period revealed no significant improvement in patients with severe sepsis, but the number of extreme deviations from the blood plasma values could be reduced. Improved concurrence of glucose readings via a 6-hour run-in period could only be achieved in patients after major cardiac surgery.
Highlights
In recent years, clinical management of glycaemia in critically ill patients has tremendously changed
The aim of the present study was to investigate the accuracy of continuous subcutaneous glucose monitoring by means of microdialysis in two different critically ill patient populations (surgical patients after major cardiac surgery (SICU group) and medical patients with severe sepsis (MICU group) and to investigate whether the prolongation of the run-in period improves the signal quality
For the MICU group, glucose concentration calibrated at hour 6 was found at 8.1 (6.5; 10.0) mmol/l versus a reference arterial blood value of 7.9 (7.0; 9.3) mmol/l (p = 0.014)
Summary
Clinical management of glycaemia in critically ill patients has tremendously changed. Evidence suggests that near-normal target ranges (7.2 – 8 mmol/l) are safe and do translate to lower mortality To achieve these goals, glucose concentration should be measured by repeated arterial measurements using a blood gas analyser - the gold standard in critical care[3]. Venous microdialysis was shown to be a highly accurate and reliable method for continuous blood glucose monitoring up to 48 hours in patients undergoing cardiac surgery in intensive care units (ICU)[15], but if the subcutaneous tissue is a reliable spot for glucose measurement has not been proven. It is known that microdialysis[16] as well as CGM systems[17] differ in relation to the stage and type of sepsis, which might exacerbate obtaining a precise interstitial glucose measurement
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
