Agreement Between Bedside Blood and Plasma Glucose Measurement in the ICU Setting

Finkielman, Javier D.; Oyen, Lance J.; Afessa, Bekele

doi:10.1378/chest.127.5.1749

Cited by 105 publications

(55 citation statements)

References 6 publications

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“…In this study, frequencies of both hyperglycemia and hypoglycemia were increased with increasing assay imprecision. In a 2005 study of ICU patients (140 ), the agreement of meter results with accredited laboratory results was poor: Among 767 paired results, the 95% limits of agreement were ϩ2.4 to Ϫ1.5 mmol/L (ϩ43.1 to Ϫ27.2 mg/dL). Hoedemaekers et al (141 ), in a study of 197 arterial blood samples from ICU patients, reported that the evaluated meter did not meet the ISO total-error criteria.…”

Section: Gppmentioning

confidence: 99%

Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus

et al. 2011

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BACKGROUND Multiple laboratory tests are used to diagnose and manage patients with diabetes mellitus. The quality of the scientific evidence supporting the use of these tests varies substantially. APPROACH An expert committee compiled evidence-based recommendations for the use of laboratory testing for patients with diabetes. A new system was developed to grade the overall quality of the evidence and the strength of the recommendations. Draft guidelines were posted on the Internet and presented at the 2007 Arnold O. Beckman Conference. The document was modified in response to oral and written comments, and a revised draft was posted in 2010 and again modified in response to written comments. The National Academy of Clinical Biochemistry and the Evidence Based Laboratory Medicine Committee of the AACC jointly reviewed the guidelines, which were accepted after revisions by the Professional Practice Committee and subsequently approved by the Executive Committee of the American Diabetes Association. CONTENT In addition to long-standing criteria based on measurement of plasma glucose, diabetes can be diagnosed by demonstrating increased blood hemoglobin A1c (Hb A1c) concentrations. Monitoring of glycemic control is performed by self-monitoring of plasma or blood glucose with meters and by laboratory analysis of Hb A1c. The potential roles of noninvasive glucose monitoring, genetic testing, and measurement of autoantibodies, urine albumin, insulin, proinsulin, C-peptide, and other analytes are addressed. SUMMARY The guidelines provide specific recommendations that are based on published data or derived from expert consensus. Several analytes have minimal clinical value at present, and their measurement is not recommended.

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Section: Gppmentioning

confidence: 99%

Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus

et al. 2011

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“…Although the performance of glucometers (including the Bayer Glucometer Elite) when compared with laboratory methods has been validated [12], scepticism remains about their relative accuracy, particularly in the critical care setting where tight glycaemic control is desirable [13][14][15] ). In the case of the latter, confirmation of the result with a laboratory sample is recommended.…”

Section: Interpretation Of Blood Glucose Readings From Different Testmentioning

confidence: 99%

Fatal neuroglycopaenia after accidental use of a glucose 5% solution in a peripheral arterial cannula flush system

2007

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SummaryA patient on an Intensive Care Unit who was recovering from multiple organ failure was being given an intravenous infusion of insulin to maintain normoglycaemia. On her 20th day in the unit, she suddenly became unresponsive. A cerebrovascular accident was suspected as other clinical and laboratory parameters remained normal apart from a blood glucose value of 20.6 mmol.l−1. The insulin infusion rate had been increased to treat hyperglycaemia. Subsequent bedside finger prick blood testing suggested that the blood sugar was low but no numerical reading was provided. Repeat blood glucose analysis using a further sample drawn from the arterial line and measured in the blood gas analyser gave a value of 10.1 mmol.l−1. Confirmatory laboratory blood tests revealed severe hypoglycaemia (0.1 mmol.l−1) and intravenous glucose 50% was given immediately. Examination showed that a glucose 5% solution had been inadvertently used in the arterial cannula flush system rather than saline, contaminating earlier samples drawn from the arterial line and giving falsely high blood glucose values. The prolonged period of severe hypoglycaemia led to neuroglycopaenia and irreversible brain injury. The patient died 9 days later without regaining consciousness. Such a complication has not previously been reported in this context and has particular significance given the increasing use of insulin therapy to maintain normoglycaemia in critically ill patients.

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“…These differences directly impact the calculation of point accuracy with a glucose monitoring device. [73][74][75][76][77][78][79][80] The calculation of point accuracy of a glucose monitoring device may be further decreased due to contamination and/or dilution of reference blood samples with glucose-free or glucose-containing parenteral solutions. Dilution of the reference blood sample with a glucose-free solution tends to lower the plasma glucose concentration by a small percentage.…”

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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Agreement Between Bedside Blood and Plasma Glucose Measurement in the ICU Setting

Cited by 105 publications

References 6 publications

Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus

Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus

Fatal neuroglycopaenia after accidental use of a glucose 5% solution in a peripheral arterial cannula flush system

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

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