Accuracy and reliability of a subcutaneous continuous glucose-monitoring system in critically ill patients

作者：Brunner Richard; Kitzberger Reinhard; Miehsler Wolfgang; Herkner Harald; Madl Christian; Holzinger Ulrike^*

来源：Critical Care Medicine, 2011, 39(4): 659-664.

DOI：10.1097/CCM.0b013e318206bf2e

• glycemic control
• glucose
• insulin
• critical illness
• intensive care unit
• hypoglycemia
• hyperglycemia

Background: Continuous glucose monitoring has been proposed to optimize glucose control in critically ill patients. To achieve strict glucose regulation, accurate and reliable continuous glucose-monitoring systems are essential.
Objective: Evaluation of a subcutaneous continuous glucose-monitoring system for use in critically ill patients.
Design: Pooled-data analysis of two prospective, randomized, controlled trials.
Setting: An eight-bed medical intensive care unit of a university hospital.
Patients: A total of 174 critically ill patients on intensive insulin therapy.
Interventions: Subcutaneous continuous glucose monitoring.
Measurements: Two thousand forty-five continuous glucose-monitoring system sensor glucose values were compared with arterial reference blood glucose levels, determined by a blood gas analyzer. Continuous glucose monitoring data were recorded continuously for up to 72 hrs by using a subcutaneous continuous glucose-monitoring sensor. The correlation of both methods and differences between continuous glucose-monitoring systems and reference values were calculated, as well as the conformity of continuous glucose-monitoring values with the International Organization for Standardization criteria (<0.83 mmol/L [15 mg/dL] difference for glucose values <= 4.12 mmol/L [>= 75 mg/dL] and <20% difference for glucose values >4.12 mmol/L [>75 mg/dL]).
Results: The Pearson correlation coefficient was 0.92, showing strong correlation between the two methods. The intraclass correlation coefficient was 0.92, indicating that 92% of the variability is due to subjects and measurement occasions. Mean difference between continuous glucose-monitoring system and reference values was -0.10 mmol/L (confidence interval: -0.13 to -0.07) (-2 mg/dL [confidence interval: -2 to -1]) (continuous glucose-monitoring system minus reference) and absolute difference 0.44 mmol/L (confidence interval: 0.41-0.47) (8 mg/dL [confidence interval: 7-8]). According to the insulin titration error grid analysis, 99.1% of continuous glucose-monitoring system values were in the acceptable treatment zone. No continuous glucose-monitoring system measurements were found in the life-threatening zone, and 92.9% of the continuous glucose-monitoring system glucose values met the International Organization for Standardization criteria.
Conclusion: The subcutaneous continuous glucose-monitoring system is reliable for use in critically ill patients and showed glucose values with a strong correlation to arterial reference blood glucose levels, determined by a blood gas analyzer. (Crit Care Med 2011; 39: 659-664)

• 出版日期2011-4