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Abstract
IntroductionGlucose control to prevent both hyperglycemia and hypoglycemia is important in an intensive care unit. Arterial blood gas analyzers and glucose meters are commonly used to measure blood-glucose concentration in an intensive care unit; however, their accuracies are still unclear.MethodsWe performed a systematic literature search (January 1, 2001, to August 31, 2012) to find clinical studies comparing blood-glucose values measured with glucose meters and/or arterial blood gas analyzers with those simultaneously measured with a central laboratory machine in critically ill adult patients.ResultsWe reviewed 879 articles and found 21 studies in which the accuracy of blood-glucose monitoring by arterial blood gas analyzers and/or glucometers by using central laboratory methods as references was assessed in critically ill adult patients. Of those 21 studies, 11 studies in which International Organization for Standardization criteria, error-grid method, or percentage of values within 20% of the error of a reference were used were selected for evaluation. The accuracy of blood-glucose measurements by arterial blood gas analyzers and glucose meters by using arterial blood was significantly higher than that of measurements with glucose meters by using capillary blood (odds ratios for error: 0.04, P < 0.001; and 0.36, P < 0.001). The accuracy of blood-glucose measurements with arterial blood gas analyzers tended to be higher than that of measurements with glucose meters by using arterial blood (P = 0.20). In the hypoglycemic range (defined as < 81 mg/dl), the incidence of errors using these devices was higher than that in the nonhypoglycemic range (odds ratios for error: arterial blood gas analyzers, 1.86, P = 0.15; glucose meters with capillary blood, 1.84, P = 0.03; glucose meters with arterial blood, 2.33, P = 0.02). Unstable hemodynamics (edema and use of a vasopressor) and use of insulin were associated with increased error of blood glucose monitoring with glucose meters.ConclusionsOur literature review showed that the accuracy of blood-glucose measurements with arterial blood gas analyzers was significantly higher than that of measurements with glucose meters by using capillary blood and tended to be higher than that of measurements with glucose meters by using arterial blood. These results should be interpreted with caution because of the large variation of accuracy among devices. Because blood-glucose monitoring was less accurate within or near the hypoglycemic range, especially in patients with unstable hemodynamics or receiving insulin infusion, we should be aware that current blood glucose-monitoring technology has not reached a high enough degree of accuracy and reliability to lead to appropriate glucose control in critically ill patients.
Highlights
Glucose control to prevent both hyperglycemia and hypoglycemia is important in an intensive care unit
Electronic database We performed a systematic literature search (January 1, 2001, through August 31, 2012) to find clinical studies comparing blood-glucose values measured by using arterial blood gas analyzers (ABGs) and/or glucose meters with those simultaneously measured with a central laboratory machine in critically ill adult patients
Inclusion and exclusion criteria Inclusion criteria for the current systematic review were as follows: (a) studies conducted in critically ill adult patients, (b) studies in which the accuracy of glucose monitoring was assessed by using ABGs and/or glucose meters, (c) studies in which Glu-lab values were used as reference values, and (d) articles presenting an appropriate summary of statistics
Summary
Glucose control to prevent both hyperglycemia and hypoglycemia is important in an intensive care unit. Arterial blood gas analyzers and glucose meters are commonly used to measure blood-glucose concentration in an intensive care unit; their accuracies are still unclear. Arterial blood gas analyzers (ABGs) and/or glucose meters, not Glu-lab, are commonly used to measure blood-glucose concentrations in critically ill patients, because of their convenience and speed [10]. Because most of these devices were not developed to guide the administration of insulin in critically ill patients, they might not be sufficiently accurate to guide therapy aimed at maintaining blood glucose within a 30-mg/dl range [11]. No systematic literature review has assessed the agreement of measurements by ABGs and/or glucose meters in critically ill patients
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