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

Christina Blixt,Olav Rooyackers,Jan Wernerman,Bengt Isaksson

doi:10.1186/cc12713

Christina Blixt, Olav Rooyackers + Show 2 more

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https://doi.org/10.1186/cc12713

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Abstract

IntroductionTight glucose control in the ICU has been proven difficult with an increased risk for hypoglycaemic episodes. Also the variability of glucose may have an impact on morbidity. An accurate and feasible on-line/continuous measurement is therefore desired. In this study a central vein catheter with a microdialysis membrane in combination with an on-line analyzer for continuous monitoring of circulating glucose and lactate by the central route was tested.MethodsA total of 10 patients scheduled for major upper abdominal surgery were included in this observational prospective study at a university hospital. The patients received an extra central venous catheter with a microdialysis membrane placed in the right jugular vein. Continuous microdialysis measurement proceeded for 20 hours and on-line values were recorded every minute. Reference arterial plasma glucose and blood lactate samples were collected every hour.ResultsMean microdialysis-glucose during measurements was 9.8 ± 2.4mmol/l.No statistical difference in the readings was seen using a single calibration compared to eighth hour calibration (P =0.09; t-test). There was a close agreement between the continuous reading and the reference plasma glucose values with an absolute difference of 0.6+0.8mmol, or 6.8+9.3% and measurements showed high correlation to plasma readings (r = 0.92). Thelimit of agreement was 23.0%(1.94 mmol/l) compared to arterial plasma values with a line of equality close to zero.However, in a Clarke-Error Grid 93.3% of the values are in the A-area,and the remaining part in the B-area.Mean microdialysis-lactate was 1.3 ± 1.1mmol/l. The measurements showed high correlation to the blood readings (r = 0.93).ConclusionContinuous on-line microdialysis glucose measurement in a central vein is a potential useful technique for continuous glucose monitoring in critically ill patients, but more improvements and testingare needed.

Highlights

Tight glucose control in the ICU has been proven difficult with an increased risk for hypoglycaemic episodes
No adverse events were observed that were associated with the central vein catheter or with the microdialysis membrane
This study has demonstrated that intravascular online microdialysis technique can be a useful tool for continuous glucose measurement

Summary

Introduction

Tight glucose control in the ICU has been proven difficult with an increased risk for hypoglycaemic episodes. A positive effect of a tight glucose control in critically ill patients treated in the ICU was postulated a decade ago. The initial study in 2001 demonstrated a remarkable effect on both mortality and morbidity in ICU patients [1]. A concern for an increased risk for hypoglycaemia with the intensive insulin treatment has emerged. Up to 18% of the patients subjected to intensive insulin treatment have had episodes of hypoglycaemia [3]. Whether these hypoglycaemic periods have an impact on the worsened outcome is debated. Recent studies point to a correlation between the variability of glucose and mortality [6,7,8]

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