Blood Glucose Measurements in Critically Ill Patients

Herpe, Tom Van; Mesotten, Dieter

doi:10.1177/193229681200600104

Cited by 13 publications

(15 citation statements)

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“…Several subcutaneous devices have been tested in critically ill patients and have been shown to have good agreement with reference arterial and venous samples [12,22-24]. Moreover, similar accuracy has been reported in critically ill patients with and without shock requiring norepinephrine therapy [22], and in cardiac surgery versus non-critically ill patients [25,26]. Nevertheless, the accuracy of interstitial fluid monitoring needs to be further investigated, in particular in unstable patients.…”

Section: Continuous Glucose Monitoringmentioning

confidence: 83%

Continuous glucose control in the ICU: report of a 2013 round table meeting

et al. 2014

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Achieving adequate glucose control in critically ill patients is a complex but important part of optimal patient management. Until relatively recently, intermittent measurements of blood glucose have been the only means of monitoring blood glucose levels. With growing interest in the possible beneficial effects of continuous over intermittent monitoring and the development of several continuous glucose monitoring (CGM) systems, a round table conference was convened to discuss and, where possible, reach consensus on the various aspects related to glucose monitoring and management using these systems. In this report, we discuss the advantages and limitations of the different types of devices available, the potential advantages of continuous over intermittent testing, the relative importance of trend and point accuracy, the standards necessary for reporting results in clinical trials and for recognition by official bodies, and the changes that may be needed in current glucose management protocols as a result of a move towards increased use of CGM. We close with a list of the research priorities in this field, which will be necessary if CGM is to become a routine part of daily practice in the management of critically ill patients.

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Section: Continuous Glucose Monitoringmentioning

confidence: 83%

Continuous glucose control in the ICU: report of a 2013 round table meeting

et al. 2014

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“…The ICU community is now convinced that more attention should be paid to the accuracy of blood glucose meters and the adequacy of insulin dosage calculators (12)(13)(14). The impact of sensor inaccuracy on insulin dosing errors may also be algorithm dependent.…”

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confidence: 99%

Modeling of Effect of Glucose Sensor Errors on Insulin Dosage and Glucose Bolus Computed by LOGIC-Insulin

et al. 2014

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BACKGROUND Effective and safe glycemic control in critically ill patients requires accurate glucose sensors and adequate insulin dosage calculators. The LOGIC-Insulin calculator for glycemic control has recently been validated in the LOGIC-1 randomized controlled trial. In this study, we aimed to determine the allowable error for intermittent and continuous glucose sensors, on the basis of the LOGIC-Insulin calculator. METHODS A gaussian simulation model with a varying bias (0%–20%) and CV (−20% to +20%) simulated blood glucose values from the LOGIC-1 study (n = 149 patients) in 10 Monte Carlo steps. A clinical error grid system was developed to compare the simulated LOGIC-Insulin–directed intervention with the nominal intervention (0% bias, 0% CV). The severity of error measuring the clinical effect of the simulated LOGIC-Insulin intervention was graded as type B, C, and D errors. Type D errors were classified as acutely life-threatening (0% probability preferred). RESULTS The probability of all types of errors was lower for continuous sensors compared with intermittent sensors. The maximum total error (TE), defined as the first TE introducing a type B/C/D error, was similar for both sensor types. To avoid type D errors, TEs <15.7% for intermittent sensors and <17.8% for continuous sensors were required. Mean absolute relative difference thresholds for type C errors were 7.1% for intermittent and 11.0% for continuous sensors. CONCLUSIONS Continuous sensors had a lower probability for clinical errors than intermittent sensors at the same accuracy level. These simulations demonstrated the suitability of the LOGIC-Insulin control system for use with continuous, as well as intermittent, sensors.

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“…A ADA sugere que valores abaixo de 70 mg/dl sejam considerados críticos, e o National Health Service Diabetes Guideline define hipoglicemia como qualquer valor de glicose sanguínea abaixo de 70 mg/dl" (12) . A hipoglicemia é classificada de acordo com a intensidade do evento hipoglicêmico, o qual pode ser avaliado a partir de valores glicêmicos, e pelo aparecimento ou não de sinais e sintomas (5,6,(11)(12)(13)(14)(15)(16) .…”

Section: Lista De Tabelasunclassified

“…Nas UTIs, a medida da glicose sanguínea é realizada, geralmente, por meio de glicosímetros portáteis. A aferição precisa e confiável é de difícil obtenção e complexa (8,14,15) . A glicemia real difere da glicemia aferida.…”

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“…A glicemia real difere da glicemia aferida. A medida da glicose sanguínea pode ser influenciada por fatores que incluem tipo de sangue, pressão arterial de oxigênio no sangue, pH, hematócrito, uso de medicamentos como paracetamol e vitamina C, manuseio dos glicosímetros por operador inexperiente, período de validade das tiras utilizadas, calor e umidade (14,15,17) . (14,18,19) .…”

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Hipoglicemia e fatores de risco em pacientes críticos com controle glicêmico: estudo de coorte

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A Deus Pai, de quem vem toda a boa dádiva e todo dom perfeito, por permitir esta caminhada e me abençoar no curso dela. À minha querida orientadora Prof. Dra. Silvia Regina Secoli que com graça me mostrou os caminhos da pesquisa e junto ensinou muito acerca da busca do conhecimento, da intensa dedicação e do compromisso. Sinto que cresci muito a partir das oportunidades que me deu. Muito obrigado. À Prof.ª Dr.ª Katia Grillo Padilha por todo o incentivo, por oportunizar a pesquisa no "Projeto Universal", e por participar de etapas importantes deste trabalho. Ao Prof. Dr. Luis Ricardo Barbosa pelo paciente trabalho de estatística e por todas as ideias que melhoraram este trabalho. À Dr.ª Renata Mahfuz Daud Gallotti e à Dr.ª Eliane Ribeiro pelas sugestões e contribuições no Exame de Qualificação. Ao meu chefe Me. Adriano Rogério Baldacin Rodrigues, pelo importante apoio na época de formulação do projeto e durante toda a execução do trabalho. À Dra. Naury de Jesus Danzi Soares, pela benção de me apontar os caminhos do mestrado, pelo exemplo e pelas palavras de ânimo. À minha esposa que se esforçou tantas vezes para que eu pudesse me dedicar a este trabalho. Sem você este trabalho não seria possível. Você é maravilhosa. Aos meus sogros José Roberto e Cleide pela ajuda tão importante ao cuidarem do Emanuel, e pelas orações. Fábio e Ana também agradeço a vocês pelo carinho e ajuda com o Emanuel. Aos pastores Euclides, José Roberto e Mateus, e aos irmãos da igreja que oraram por mim durante este tempo e me apoiaram.

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Blood Glucose Measurements in Critically Ill Patients

Cited by 13 publications

References 49 publications

Continuous glucose control in the ICU: report of a 2013 round table meeting

Continuous glucose control in the ICU: report of a 2013 round table meeting

Modeling of Effect of Glucose Sensor Errors on Insulin Dosage and Glucose Bolus Computed by LOGIC-Insulin

Hipoglicemia e fatores de risco em pacientes críticos com controle glicêmico: estudo de coorte

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