INTRODUCTION:To obtain strict glucose regulation, an accurate and feasible bedside glucometry method is essential. We evaluated three different types of point-of-care glucometry in seriously ill intensive care unit (ICU) patients. The study was performed as a single-centre, prospective, observational study in a 12-bed medical ICU of a university hospital. METHODS:Patients with an expected ICU stay of more than 48 hours were included. Because the reference laboratory delivers glucose values after approximately 30 to 60 minutes, which is too slow to use in a glucose regulation protocol and for calibration of the subcutaneous continuous glucose monitoring system (CGMS) (CGMS System Gold), we first validated the ICU-based blood gas/glucose analyser ABL715 (part 1 of the study). Subsequently, part 2 was performed: after inserting (and calibrating) the subcutaneous CGMS, heparinised arterial blood samples were drawn from an arterial line every 6 hours and analysed on both the Precision PCx point-of-care meter using test strips and on the blood gas/glucose analyser ABL715. CGMS glucose data were downloaded after 24 to 72 hours. The results of the paired measurements were analysed as a scatter plot by the method of Bland and Altman and were expressed as a correlation coefficient. RESULTS:Part 1: Four hundred and twenty-four blood samples were drawn from 45 critically ill ICU patients. The ICU-based blood gas/glucose analyser ABL715 provided a good estimate of conventional laboratory glucose assessment: the correlation coefficient was 0.95. In the Clarke error grid, 96.8% of the paired measurements were in the clinically acceptable zones A and B. Part 2: One hundred sixty-five paired samples were drawn from 19 ICU patients. The Precision PCx point-of-care meter showed a correlation coefficient of 0.89. Ninety-eight point seven percent of measurements were within zones A and B. The correlation coefficient for the subcutaneous CGMS System Gold was 0.89. One hundred percent of measurements were within zones A and B. CONCLUSION:The ICU-based blood glucose analyser ABL715 is a rapid and accurate alternative for laboratory glucose determination and can serve as a standard for ICU blood glucose measurements. The Precision PCx is a good alternative, but feasibility may be limited because of the blood sample handling. The subcutaneous CGMS System Gold is promising, but real-time glucose level reporting is necessary before it can be of clinical use in the ICU. When implementing a glucose-insulin algorithm in patient care or research, one should realise that the absolute glucose level may differ systematically among various measuring methods, influencing targeted glucose levels.

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简介:要获得严格的葡萄糖调节,准确,可行的床旁血糖测定方法必不可少。我们评估了重症重症监护病房(ICU)患者的三种不同的即时护理血糖仪。该研究是在大学医院的12张病床的ICU中进行的单中心,前瞻性,观察性研究。
方法:包括预期ICU超过48小时的患者。由于参考实验室在大约30至60分钟后会提供葡萄糖值,这太慢了,无法用于葡萄糖调节方案以及皮下连续葡萄糖监测系统(CGMS)(CGMS System Gold)的校准,因此我们首先验证了ICU-血气/葡萄糖分析仪ABL715(研究的第1部分)。随后,执行第2部分:插入(并校准)皮下CGMS后,每6小时从一条动脉管线中抽取肝素化的动脉血样本,并在Precision PCx即时检测仪上使用试纸条和血液进行分析气体/葡萄糖分析仪ABL715。 CGMS葡萄糖数据在24到72小时后下载。配对测量的结果通过Bland和Altman方法作为散点图进行分析,并表示为相关系数。
结果:第1部分:从45名重症ICU患者中抽取了242份血液样本。基于ICU的血气/葡萄糖分析仪ABL715提供了常规实验室葡萄糖评估的良好估计:相关系数为0.95。在Clarke误差网格中,96.8%的配对测量值在临床上可接受的区域A和B中。第2部分:从19位ICU患者中抽取了165个配对样品。 Precision PCx即时护理仪的相关系数为0.89。百分之九十八的测量值在区域A和B内。皮下CGMS系统Gold的相关系数为0.89。百分之一百的测量值在区域A和B内。
结论:基于ICU的血糖分析仪ABL715是一种快速准确的实验室葡萄糖测定方法,可作为ICU血糖测量的标准。 Precision PCx是一个很好的选择,但由于血液样本的处理,可行性可能受到限制。皮下CGMS System Gold前景看好,但在ICU中临床应用之前,必须实时报告葡萄糖水平。在患者护理或研究中实施葡萄糖-胰岛素算法时,应认识到,各种测量方法之间的绝对葡萄糖水平可能会系统地不同,从而影响目标血糖水平。

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