1
|
Fang J, Huang S, Liu F, He G, Li X, Huang X, Chen HJ, Xie X. Semi-Implantable Bioelectronics. NANO-MICRO LETTERS 2022; 14:125. [PMID: 35633391 PMCID: PMC9148344 DOI: 10.1007/s40820-022-00818-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/09/2022] [Indexed: 06/15/2023]
Abstract
Developing techniques to effectively and real-time monitor and regulate the interior environment of biological objects is significantly important for many biomedical engineering and scientific applications, including drug delivery, electrophysiological recording and regulation of intracellular activities. Semi-implantable bioelectronics is currently a hot spot in biomedical engineering research area, because it not only meets the increasing technical demands for precise detection or regulation of biological activities, but also provides a desirable platform for externally incorporating complex functionalities and electronic integration. Although there is less definition and summary to distinguish it from the well-reviewed non-invasive bioelectronics and fully implantable bioelectronics, semi-implantable bioelectronics have emerged as highly unique technology to boost the development of biochips and smart wearable device. Here, we reviewed the recent progress in this field and raised the concept of "Semi-implantable bioelectronics", summarizing the principle and strategies of semi-implantable device for cell applications and in vivo applications, discussing the typical methodologies to access to intracellular environment or in vivo environment, biosafety aspects and typical applications. This review is meaningful for understanding in-depth the design principles, materials fabrication techniques, device integration processes, cell/tissue penetration methodologies, biosafety aspects, and applications strategies that are essential to the development of future minimally invasive bioelectronics.
Collapse
Affiliation(s)
- Jiaru Fang
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-Sen University, Guangzhou, 510006, People's Republic of China
| | - Shuang Huang
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-Sen University, Guangzhou, 510006, People's Republic of China
| | - Fanmao Liu
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-Sen University, Guangzhou, 510006, People's Republic of China
| | - Gen He
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-Sen University, Guangzhou, 510006, People's Republic of China
| | - Xiangling Li
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-Sen University, Guangzhou, 510006, People's Republic of China
| | - Xinshuo Huang
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-Sen University, Guangzhou, 510006, People's Republic of China
| | - Hui-Jiuan Chen
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-Sen University, Guangzhou, 510006, People's Republic of China
| | - Xi Xie
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-Sen University, Guangzhou, 510006, People's Republic of China.
| |
Collapse
|
2
|
Forsse A, Nielsen TH, Mølstrøm S, Hjelmborg J, Nielsen KS, Nygaard KH, Yilmaz S, Nordström CH, Poulsen FR. A Prospective Observational Feasibility Study of Jugular Bulb Microdialysis in Subarachnoid Hemorrhage. Neurocrit Care 2021; 33:241-255. [PMID: 31845174 DOI: 10.1007/s12028-019-00888-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Cerebral metabolic perturbations are common in aneurysmal subarachnoid hemorrhage (aSAH). Monitoring cerebral metabolism with intracerebral microdialysis (CMD) allows early detection of secondary injury and may guide decisions on neurocritical care interventions, affecting outcome. However, CMD is a regional measuring technique that is influenced by proximity to focal lesions. Continuous microdialysis of the cerebral venous drainage may provide information on global cerebral metabolism relevant for the care of aSAH patients. This observational study aimed to explore the feasibility of jugular bulb microdialysis (JBMD) in aSAH and describe the output characteristics in relation to conventional multimodal monitoring. METHODS Patients with severe aSAH were included at admission or after in-house deterioration when local clinical guidelines prompted extended multimodal monitoring. Non-dominant frontal CMD, intracranial pressure (ICP), partial brain tissue oxygenation pressure (PbtO2), and cerebral perfusion pressure (CPP) were recorded every hour. The dominant jugular vein was accessed by retrograde insertion of a microdialysis catheter with the tip placed in the jugular bulb under ultrasound guidance. Glucose, lactate, pyruvate, lactate/pyruvate ratio, glycerol, and glutamate were studied for correlation to intracranial measurements. Modified Rankin scale was assessed at 6 months. RESULTS Twelve adult aSAH patients were monitored during a mean 4.2 ± 2.6 days yielding 22,041 data points for analysis. No complications related to JBMD were observed. Moderate or strong significant monotonic CMD-to-JBMD correlations were observed most often for glucose (7 patients), followed by lactate (5 patients), and pyruvate, glycerol, and glutamate (3 patients). Moderate correlation for lactate/pyruvate ratio was only seen in one patient. Analysis of critical periods defined by ICP > 20, CPP < 65, or PbtO2 < 15 revealed a tendency toward stronger CMD-to-JBMD associations in patients with many or long critical periods. Possible time lags between CMD and JBMD measurements were only identified in 6 out of 60 patient variables. With the exception of pyruvate, a dichotomized outcome was associated with similar metabolite patterns in JBMD and CMD. A nonsignificant tendency toward greater differences between outcome groups was seen in JBMD. CONCLUSIONS Continuous microdialysis monitoring of the cerebral drainage in the jugular bulb is feasible and safe. JBMD-to-CMD correlation is influenced by the type of metabolite measured, with glucose and lactate displaying the strongest associations. JBMD lactate correlated more often than CMD lactate to CPP, implying utility for detection of global cerebral metabolic perturbations. Studies comparing JBMD to other global measures of cerebral metabolism, e.g., PET CT or Xenon CT, are warranted.
Collapse
Affiliation(s)
- Axel Forsse
- Department of Neurosurgery, Odense University Hospital, Sønder Boulevard 29, 5000, Odense, Denmark. .,BRIDGE - Brain Research - Inter-Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Troels Halfeld Nielsen
- Department of Neurosurgery, Odense University Hospital, Sønder Boulevard 29, 5000, Odense, Denmark.,BRIDGE - Brain Research - Inter-Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Simon Mølstrøm
- Department of Anesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
| | - Jacob Hjelmborg
- Department of Biostatistics and Epidemiology, University of Southern Denmark, Odense, Denmark
| | - Kasper Stokbro Nielsen
- Department of Oral and Maxillofacial Surgery, Odense University Hospital, Odense, Denmark
| | - Kevin Hebøll Nygaard
- Department of Neurosurgery, Odense University Hospital, Sønder Boulevard 29, 5000, Odense, Denmark.,BRIDGE - Brain Research - Inter-Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Sibel Yilmaz
- Department of Neurosurgery, Odense University Hospital, Sønder Boulevard 29, 5000, Odense, Denmark
| | - Carl-Henrik Nordström
- Department of Neurosurgery, Odense University Hospital, Sønder Boulevard 29, 5000, Odense, Denmark.,BRIDGE - Brain Research - Inter-Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Frantz Rom Poulsen
- Department of Neurosurgery, Odense University Hospital, Sønder Boulevard 29, 5000, Odense, Denmark.,BRIDGE - Brain Research - Inter-Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
3
|
Accuracy and stability of an arterial sensor for glucose monitoring in a porcine model using glucose clamp technique. Sci Rep 2020; 10:6604. [PMID: 32313062 PMCID: PMC7170864 DOI: 10.1038/s41598-020-63659-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 04/03/2020] [Indexed: 01/08/2023] Open
Abstract
Intravascular glucose sensors have the potential to improve and facilitate glycemic control in critically ill patients and might overcome measurement delay and accuracy issues. This study investigated the accuracy and stability of a biosensor for arterial glucose monitoring tested in a hypo- and hyperglycemic clamp experiment in pigs. 12 sensors were tested over 5 consecutive days in 6 different pigs. Samples of sensor and reference measurement pairs were obtained every 15 minutes. 1337 pairs of glucose values (range 37–458 mg/dl) were available for analysis. The systems met ISO 15197:2013 criteria in 99.2% in total, 100% for glucose <100 mg/dl (n = 414) and 98.8% for glucose ≥100 mg/dl (n = 923). The mean absolute relative difference (MARD) during the entire glycemic range of all sensors was 4.3%. The MARDs within the hypoglycemic (<70 mg/dl), euglycemic (≥70–180 mg/dl) and hyperglycemic glucose ranges (≥180 mg/dl) were 6.1%, 3.6% and 4.7%, respectively. Sensors indicated comparable performance on all days investigated (day 1, 3 and 5). None of the systems showed premature failures. In a porcine model, the performance of the biosensor revealed a promising performance. The transfer of these results into a human setting is the logical next step.
Collapse
|
4
|
van der Mast JE, Nijsten MW, Alffenaar JC, Touw DJ, Bult W. In vitro evaluation of an intravenous microdialysis catheter for therapeutic drug monitoring of gentamicin and vancomycin. Pharmacol Res Perspect 2019; 7:e00483. [PMID: 31333845 PMCID: PMC6594919 DOI: 10.1002/prp2.483] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 03/14/2019] [Accepted: 03/31/2019] [Indexed: 01/06/2023] Open
Abstract
A central venous catheter with a built-in microdialysis membrane is available for continuous lactate and glucose monitoring in the intensive care unit (ICU). As this catheter might also be suitable for repeated measurements of unbound drug levels, we studied in vitro the feasibility of monitoring unbound antibiotic concentrations. The catheter was placed in various media at 37°C spiked with gentamicin or vancomycin. Dialysate fractions were repeatedly collected over 3 hours with a NaCl 0.9% perfusate flow of 5 μL/min. Total and unbound drug concentrations in medium and perfusate were measured by immunoassay. After 60 minutes stable recovery for both drugs was observed, with mean ±SD relative recoveries of vancomycin and gentamicin in human serum of 64% ±0.4% and 73% ±3%. The recoveries of the unbound concentrations were 91% ±3% and 91% ±4%. This intravenous microdialysis system may be a very useful platform for therapeutic drug monitoring in the ICU.
Collapse
Affiliation(s)
- Jackelien E. van der Mast
- Department of Clinical Pharmacy and PharmacologyUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
- Department of Clinical PharmacyMáxima Medical CenterVeldhovenThe Netherlands
| | - Maarten W. Nijsten
- Department of Critical CareUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Jan‐Willem C. Alffenaar
- Department of Clinical Pharmacy and PharmacologyUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Daan J. Touw
- Department of Clinical Pharmacy and PharmacologyUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
- Department of Pharmacy, section Pharmacokinetics, toxicology and targetingUniversity of GroningenGroningenThe Netherlands
| | - Wouter Bult
- Department of Clinical Pharmacy and PharmacologyUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
- Department of Critical CareUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| |
Collapse
|
5
|
Head-to-head comparison of two continuous glucose monitoring systems on a cardio-surgical ICU. J Clin Monit Comput 2018; 33:895-901. [PMID: 30421152 DOI: 10.1007/s10877-018-0221-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 11/08/2018] [Indexed: 12/23/2022]
Abstract
In critical illness hypo-and hyperglycemia have a negative influence on patient outcome. Continuous glucose monitoring (CGM) could help in early detection of hypo-and hyperglycemia. A requirement for these new methods is an acceptable accuracy and precision in clinical practice. In this pilot study we prospectively evaluated the accuracy and precision of two CGM sensors (subcutaneous sensor: Sentrino®, Medtronic and intravasal sensor: Glucoclear®, Edwards) in 20 patients on a cardio-surgical ICU in a head to head comparison. CGM data were recorded for up to 48 h and values were compared with blood-gas-analysis (BGA) values, analysed with Bland-Altman-plots and color-coded surveillance error-grids. Shown are means ± standard deviations. In total 270/255 intravasal/subcutaneous pairs with BGA-values were analysed. The average runtime of the sensors was 28.4 ± 6.4 h. Correlation with BGA values yielded a correlation coefficient of 0.76 (subcutaneous sensor) and 0.92 (intravasal sensor). The Bland Altman Plots revealed an accuracy of 2.5 mg/dl, and a precision of + 43.0 mg/dl to - 38.0 mg/dl (subcutaneous sensor) and an accuracy of - 6.0 mg/dl, and a precision of + 12.4 mg/dl to - 24.4 mg/dl (intravasal sensor). No severe hypoglycemic event, defined as BG level below 40 mg/dl, occurred during treatment. Both sensors showed good accuracy in comparison to the BGA values, however they differ regarding precision, which in case of the subcutaneous sensor is considerable high.
Collapse
|
6
|
Lee H, Hong YJ, Baik S, Hyeon T, Kim D. Enzyme-Based Glucose Sensor: From Invasive to Wearable Device. Adv Healthc Mater 2018; 7:e1701150. [PMID: 29334198 DOI: 10.1002/adhm.201701150] [Citation(s) in RCA: 294] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 10/28/2017] [Indexed: 02/07/2023]
Abstract
Blood glucose concentration is a key indicator of patients' health, particularly for symptoms associated with diabetes mellitus. Because of the large number of diabetic patients, many approaches for glucose measurement have been studied to enable continuous and accurate glucose level monitoring. Among them, electrochemical analysis is prominent because it is simple and quantitative. This technology has been incorporated into commercialized and research-level devices from simple test strips to wearable devices and implantable systems. Although directly monitoring blood glucose assures accurate information, the invasive needle-pinching step to collect blood often results in patients (particularly young patients) being reluctant to adopt the process. An implantable glucose sensor may avoid the burden of repeated blood collections, but it is quite invasive and requires periodic replacement of the sensor owing to biofouling and its short lifetime. Therefore, noninvasive methods to estimate blood glucose levels from tears, saliva, interstitial fluid (ISF), and sweat are currently being studied. This review discusses the evolution of enzyme-based electrochemical glucose sensors, including materials, device structures, fabrication processes, and system engineering. Furthermore, invasive and noninvasive blood glucose monitoring methods using various biofluids or blood are described, highlighting the recent progress in the development of enzyme-based glucose sensors and their integrated systems.
Collapse
Affiliation(s)
- Hyunjae Lee
- Center for Nanoparticle ResearchInstitute for Basic Science (IBS) Seoul 08826 Republic of Korea
- School of Chemical and Biological EngineeringInstitute of Chemical ProcessesSeoul National University (SNU) Seoul 08826 Republic of Korea
| | - Yongseok Joseph Hong
- Center for Nanoparticle ResearchInstitute for Basic Science (IBS) Seoul 08826 Republic of Korea
- School of Chemical and Biological EngineeringInstitute of Chemical ProcessesSeoul National University (SNU) Seoul 08826 Republic of Korea
| | - Seungmin Baik
- Center for Nanoparticle ResearchInstitute for Basic Science (IBS) Seoul 08826 Republic of Korea
- School of Chemical and Biological EngineeringInstitute of Chemical ProcessesSeoul National University (SNU) Seoul 08826 Republic of Korea
| | - Taeghwan Hyeon
- Center for Nanoparticle ResearchInstitute for Basic Science (IBS) Seoul 08826 Republic of Korea
- School of Chemical and Biological EngineeringInstitute of Chemical ProcessesSeoul National University (SNU) Seoul 08826 Republic of Korea
| | - Dae‐Hyeong Kim
- Center for Nanoparticle ResearchInstitute for Basic Science (IBS) Seoul 08826 Republic of Korea
- School of Chemical and Biological EngineeringInstitute of Chemical ProcessesSeoul National University (SNU) Seoul 08826 Republic of Korea
| |
Collapse
|
7
|
Fischer MO, Gouëzel C, Fradin S, Saplacan V, Gérard JL, Fellahi JL, Hanouz JL. Assessment of changes in blood glucose concentration with intravascular microdialysis. J Clin Monit Comput 2018; 32:1135-1142. [PMID: 29404891 DOI: 10.1007/s10877-018-0111-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 02/01/2018] [Indexed: 12/25/2022]
Abstract
Blood glucose and its variability of is a major prognostic factor associated with morbidity. We hypothesized that intravenous microdialysis incorporated in a central venous catheter (CVC) would be interchangeable with changes in blood glucose measured by the reference method using a blood gas analyzer. Microdialysis and central venous blood glucose measurements were simultaneously recorded in high-risk cardiac surgical patients. The correlation between absolute values was determined by linear regression and the Bland-Altman test for repeated measurements was used to compare bias, precision, and limits of agreement. Changes in blood glucose measurement were evaluated by four-quadrant plot and trend interchangeability methods (TIM). In the 23 patients analyzed, the CVC was used as part of standard care with no complications. The correlation coefficient for absolute values (N = 99) was R = 0.91 (P < 0.001). The bias, precision and limits of agreement were - 9.1, 17.4 and - 43.2 to 24.9 mg/dL, respectively. The concordance rate for changes in blood glucose measurements (N = 77) was 85% with the four-quadrant plot. The TIM showed that 14 (18%) changes of blood glucose measurements were uninterpretable. Among the remaining 63 (82%) interpretable changes, 23 (37%) were interchangeable, 13 (20%) were in the gray zone, and 27 (43%) were not interchangeable. Microdialysis using a CVC appears to provide imprecise absolute blood glucose values with risk of insulin misuse. Moreover, only one third of changes in blood glucose measurements were interchangeable with the reference method using the TIM.
Collapse
Affiliation(s)
- Marc-Olivier Fischer
- Pôle Réanimations Anesthésie SAMU/SMUR, Department of Anaesthesia and Intensive Care Medicine, Caen University Hospital de Caen, Avenue de la Côte de Nacre, CS 30001, 14000, Caen, France.
| | - Corentin Gouëzel
- Pôle Réanimations Anesthésie SAMU/SMUR, Department of Anaesthesia and Intensive Care Medicine, Caen University Hospital de Caen, Avenue de la Côte de Nacre, CS 30001, 14000, Caen, France
| | - Sabine Fradin
- Department of Biology, University Hospital of Caen, Avenue de la Côte de Nacre, CS 30001, 14000, Caen, France
| | - Vladimir Saplacan
- Cardiac Surgery, University Hospital of Caen, Avenue de la Côte de Nacre, CS 30001, 14000, Caen, France
| | - Jean-Louis Gérard
- Pôle Réanimations Anesthésie SAMU/SMUR, Department of Anaesthesia and Intensive Care Medicine, Caen University Hospital de Caen, Avenue de la Côte de Nacre, CS 30001, 14000, Caen, France
| | - Jean-Luc Fellahi
- Department of Anaesthesia and Intensive Care Medicine, Hôpital cardiologique Louis Pradel, Avenue du Doyen Lepine, 69 677, Lyon, France.,Faculty of Medicine, University of Lyon 1 Claude Bernard, 69 008, Lyon, France
| | - Jean-Luc Hanouz
- Pôle Réanimations Anesthésie SAMU/SMUR, Department of Anaesthesia and Intensive Care Medicine, Caen University Hospital de Caen, Avenue de la Côte de Nacre, CS 30001, 14000, Caen, France
| |
Collapse
|
8
|
Zhou T, Dickson JL, Geoffrey Chase J. Autoregressive Modeling of Drift and Random Error to Characterize a Continuous Intravascular Glucose Monitoring Sensor. J Diabetes Sci Technol 2018; 12:90-104. [PMID: 28707484 PMCID: PMC5761979 DOI: 10.1177/1932296817719089] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Continuous glucose monitoring (CGM) devices have been effective in managing diabetes and offer potential benefits for use in the intensive care unit (ICU). Use of CGM devices in the ICU has been limited, primarily due to the higher point accuracy errors over currently used traditional intermittent blood glucose (BG) measures. General models of CGM errors, including drift and random errors, are lacking, but would enable better design of protocols to utilize these devices. This article presents an autoregressive (AR) based modeling method that separately characterizes the drift and random noise of the GlySure CGM sensor (GlySure Limited, Oxfordshire, UK). METHODS Clinical sensor data (n = 33) and reference measurements were used to generate 2 AR models to describe sensor drift and noise. These models were used to generate 100 Monte Carlo simulations based on reference blood glucose measurements. These were then compared to the original CGM clinical data using mean absolute relative difference (MARD) and a Trend Compass. RESULTS The point accuracy MARD was very similar between simulated and clinical data (9.6% vs 9.9%). A Trend Compass was used to assess trend accuracy, and found simulated and clinical sensor profiles were similar (simulated trend index 11.4° vs clinical trend index 10.9°). CONCLUSION The model and method accurately represents cohort sensor behavior over patients, providing a general modeling approach to any such sensor by separately characterizing each type of error that can arise in the data. Overall, it enables better protocol design based on accurate expected CGM sensor behavior, as well as enabling the analysis of what level of each type of sensor error would be necessary to obtain desired glycemic control safety and performance with a given protocol.
Collapse
Affiliation(s)
- Tony Zhou
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
- Tony Zhou, BE, Department of Mechanical Engineering, University of Canterbury, 20 Kirkwood Ave, Riccarton, Christchurch, Canterbury 8041, New Zealand.
| | - Jennifer L. Dickson
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
| | - J. Geoffrey Chase
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
| |
Collapse
|
9
|
Schierenbeck F, Franco-Cereceda A, Liska J. Accuracy of 2 Different Continuous Glucose Monitoring Systems in Patients Undergoing Cardiac Surgery. J Diabetes Sci Technol 2017; 11:108-116. [PMID: 27257168 PMCID: PMC5375060 DOI: 10.1177/1932296816651632] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Continuous glucose monitoring (CGM) is today provided by various techniques. This study aims to compare two different CGM-systems: the FreeStyle Libre subcutaneous continuous glucose monitoring system (SC-CGM) and the Eirus intravascular microdialysis continuous glucose monitoring system (MD-CGM) in patients undergoing cardiac surgery. METHODS A total of 26 patients were equipped with both the SC-CGM and the MD-CGM systems. The SC-CGM system was placed subcutaneously in the left upper-arm and the MD-CGM system was placed in the superior vena cava. Reference blood glucose values were obtained by analyzing arterial blood in a blood gas analyzer. Reference glucose values were then paired with glucose values from both CGM-systems and analyzed for accuracy. RESULTS In all, 514 paired MD-CGM/arterial blood gas glucose values and 578 paired SC-CGM/arterial blood gas glucose values were obtained. Mean difference (SD) for the MD-CGM system was 0.9 (15.1) mg/dl and for the SC-CGM system -43.4 (20) mg/dl. ISO criteria (ISO15197:2013) were not met by either CGM system. In the Clarke error grid, all paired samples were within the zones AB for the MD-CGM system, and 94% in zone A. For the SC-CGM system, 99.1% of the paired samples were within zones AB, and 18.9% in zone A. Both the MD-CGM and the SC-CGM systems were reliable and used without complications. CONCLUSIONS These results indicate that the Eirus intravascular microdialysis system monitors glucose continuously with superior accuracy compared to the FreeStyle Libre subcutaneous glucose monitoring system, which repeatedly measured a glucose value that was lower than the reference method.
Collapse
Affiliation(s)
- Fanny Schierenbeck
- Section of Cardiothoracic Surgery and Anesthesiology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- Fanny Schierenbeck, MD, Section of Cardiothoracic Surgery and Anesthesiology, Department of Molecular Medicine and Surgery, Karolinska University Hospital, 171 76 Stockholm, Sweden.
| | - Anders Franco-Cereceda
- Section of Cardiothoracic Surgery and Anesthesiology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Jan Liska
- Section of Cardiothoracic Surgery and Anesthesiology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
10
|
Leopold JH, van Hooijdonk RTM, Boshuizen M, Winters T, Bos LD, Abu-Hanna A, Hoek AMT, Fischer JC, van Dongen-Lases EC, Schultz MJ. Point and trend accuracy of a continuous intravenous microdialysis-based glucose-monitoring device in critically ill patients: a prospective study. Ann Intensive Care 2016; 6:68. [PMID: 27436191 PMCID: PMC4951389 DOI: 10.1186/s13613-016-0171-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 07/04/2016] [Indexed: 11/24/2022] Open
Abstract
Background Microdialysis is a well-established technology that can be used for continuous blood glucose monitoring. We determined point and trend accuracy, and reliability of a microdialysis-based continuous blood glucose-monitoring device (EIRUS®) in critically ill patients. Methods Prospective study involving patients with an expected intensive care unit stay of ≥48 h. Every 15 min, device readings were compared with blood glucose values measured in arterial blood during blocks of 8 h per day for a maximum of 3 days. The Clarke error grid, Bland–Altman plot, mean absolute relative difference and glucose prediction error analysis were used to express point accuracy and the rate error grid to express trend accuracy. Reliability testing included aspects of the device and the external sensor, and the special central venous catheter (CVC) with a semipermeable membrane for use with this device. Results We collected 594 paired values in 12 patients (65 [26–80; 8–97] (median [IQR; total range]) paired values per patient). Point accuracy: 93.6 % of paired values were in zone A of the Clarke error grid, 6.4 % were in zone B; bias was 4.1 mg/dL with an upper limit of agreement of 28.6 mg/dL and a lower level of agreement of −20.5 mg/dL in the Bland–Altman analysis; 93.6 % of the values ≥75 mg/dL were within 20 % of the reference values in the glucose prediction error analysis; the mean absolute relative difference was 7.5 %. Trend accuracy: 96.4 % of the paired values were in zone A, and 3.3 and 0.3 % were in zone B and zone C of the rate error grid. Reliability: out of 16 sensors, 4 had to be replaced prematurely; out of 12 CVCs, two malfunctioned (one after unintentional flushing by unsupervised nurses of the ports connected to the internal microdialysis chamber, causing rupture of the semipermeable membrane; one for an unknown reason). Device start-up time was 58 [56–67] min; availability of real-time data was 100 % of the connection time. Conclusions In this study in critically ill patients who had no hypoglycemic episodes and a limited number of hyperglycemic excursions, point accuracy of the device was moderate to good. Trend accuracy was very good. The device had no downtimes, but 4 out of 16 external sensors and 2 out of 12 CVCs had practical problems. Electronic supplementary material The online version of this article (doi:10.1186/s13613-016-0171-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- J H Leopold
- Department of Intensive Care, Academic Medical Center, Room C3-311, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. .,Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands.
| | - R T M van Hooijdonk
- Department of Intensive Care, Academic Medical Center, Room C3-311, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - M Boshuizen
- Department of Intensive Care, Academic Medical Center, Room C3-311, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - T Winters
- Department of Intensive Care, Academic Medical Center, Room C3-311, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - L D Bos
- Department of Intensive Care, Academic Medical Center, Room C3-311, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - A Abu-Hanna
- Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands
| | - A M T Hoek
- Department of Clinical Chemistry, Academic Medical Center, Amsterdam, The Netherlands
| | - J C Fischer
- Department of Clinical Chemistry, Academic Medical Center, Amsterdam, The Netherlands
| | - E C van Dongen-Lases
- Department of Clinical Chemistry, Academic Medical Center, Amsterdam, The Netherlands
| | - M J Schultz
- Department of Intensive Care, Academic Medical Center, Room C3-311, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive care and Anesthesiology (L.E.I.C.A), Academic Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
11
|
Gottschalk A, Welp HA, Leser L, Lanckohr C, Wempe C, Ellger B. Continuous Glucose Monitoring in Patients Undergoing Extracorporeal Ventricular Assist Therapy. PLoS One 2016; 11:e0148778. [PMID: 26963806 PMCID: PMC4786282 DOI: 10.1371/journal.pone.0148778] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 01/22/2016] [Indexed: 12/16/2022] Open
Abstract
Background Dysregulations of blood glucose (BG) are associated with adverse outcome in critical illness; controlling BG to target appears to improve outcome. Since BG-control is challenging in daily intensive care practice BG-control remains poor especially in patients with rapidly fluctuating BG. To improve BG-control and to avoid deleterious hypoglycemia, automated online-measurement tools are advocated. We thus evaluated the point-accuracy of the subcutaneous Sentrino® Continuous Glucose Monitoring System (CGM, Medtronic Diabetes, Northridge, California) in patients undergoing extracorporeal cardiac life support (ECLS) for cardiogenic shock. Methods Management of BG was performed according to institute’s standard aiming at BG-levels between 100–145 mg/dl. CGM-values were recorded without taking measures into therapeutic account. Point-accuracy in comparison to intermittent BG-measurement by the ABL-blood-gas analyzer was determined. Results CGM (n = 25 patients) correlated significantly with ABL-values (r = 0.733, p<0.001). Mean error from standard was 15.0 mg/dl (11.9%). 44.2% of the readings were outside a 15% range around ABL-values. In one of 635 paired data-points, ABL revealed hypoglycemia (BG 32 mg/dl) whereas CGM did not show hypoglycemic values (132mg/dl). Conclusions CGM reveals minimally invasive BG-values in critically ill adults with dynamically impaired tissue perfusion. Because of potential deviations from standard, CGM-readings must be interpreted with caution in specific ICU-populations.
Collapse
Affiliation(s)
- Antje Gottschalk
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Henryk A. Welp
- Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University Hospital Münster, Münster, Germany
- * E-mail:
| | - Laura Leser
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Christian Lanckohr
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Carola Wempe
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Björn Ellger
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| |
Collapse
|
12
|
Viana MV, Moraes RB, Fabbrin AR, Santos MF, Gerchman F. [Assessment and treatment of hyperglycemia in critically ill patients]. Rev Bras Ter Intensiva 2015; 26:71-6. [PMID: 24770692 PMCID: PMC4031893 DOI: 10.5935/0103-507x.20140011] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Accepted: 02/11/2014] [Indexed: 12/24/2022] Open
Abstract
Hyperglycemia is a commonly encountered issue in critically ill patients in the
intensive care setting. The presence of hyperglycemia is associated with increased
morbidity and mortality, regardless of the reason for admission (e.g., acute
myocardial infarction, status post-cardiovascular surgery, stroke, sepsis). However,
the pathophysiology and, in particular, the treatment of hyperglycemia in the
critically ill patient remain controversial. In clinical practice, several aspects
must be taken into account in the management of these patients, including blood
glucose targets, history of diabetes mellitus, the route of nutrition (enteral or
parenteral), and available monitoring equipment, which substantially increases the
workload of providers involved in the patients' care. This review describes the
epidemiology, pathophysiology, management, and monitoring of hyperglycemia in the
critically ill adult patient.
Collapse
Affiliation(s)
- Marina Verçoza Viana
- Serviço de Terapia Intensiva, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brasil
| | | | | | | | - Fernando Gerchman
- Serviço de Endocrinologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
| |
Collapse
|
13
|
Leopold JH, Hooijdonk RT, Boshuizen M, Winters T, Bos LD, Abu-Hanna A, Schultz MJ. Point and trend accuracy of continuous glucose monitoring using intravenous microdialysis in critically ill patients. Crit Care 2015. [PMCID: PMC4472426 DOI: 10.1186/cc14452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
14
|
Foubert LA, Lecomte PV, Nobels FR, Gulino AM, De Decker KH. Accuracy of a feasibility version of an intravenous continuous glucose monitor in volunteers with diabetes and hospitalized patients. Diabetes Technol Ther 2014; 16:858-66. [PMID: 25093257 DOI: 10.1089/dia.2014.0082] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND A feasibility version of the GlucoClear™ continuous glucose monitoring system (Edwards Lifesciences, Irvine, CA), the intravenous blood glucose (IVBG) system, developed to facilitate glycemic management, was evaluated. MATERIALS AND METHODS Two pilot studies were conducted. Ten volunteers with diabetes (1,725 matched pairs) and 10 patients scheduled for intensive care unit (ICU) admission following surgery (1,393 matched pairs) were studied. The patients' blood glucose concentrations were monitored by the IVBG system every 5 min for up to 72 h. The accuracy of the IVBG system was calculated and compared with the Yellow Springs Instrument (YSI) (Yellows Springs, OH) and Radiometer (Copenhagen, Denmark) measurements to determine the percentage of matched pairs that met 15/20%, 10/15%, 12/12.5%, and 10/10% assessment criteria. Performance was calculated as the percentage of the total measurements that would have been displayed in an unblinded study. Adverse events were monitored. RESULTS The accuracy of the IVBG system met the International Organization for Standardization ISO 15197 15/20% criterion (99.07% in volunteers, 99.43% in the ICU, and both vs. YSI) and the stricter 10/15% criterion (96.17% in volunteers, 96.77% in the ICU, and both vs. YSI) over the 72-h period and across a broad range of blood glucose concentrations. Performance was 89.97% in the ICU study. The adverse device effects included induration of the peripheral vein, mild bruising, and mild hematoma. In the volunteers, there were patency problems with six catheters. CONCLUSIONS The IVBG system is safe, accurate, and reliable. This minimally invasive system was not affected by potentially interfering medications. Real-time measurements, alarms, and trends provided by the IVBG system might support glycemic control protocols and prevent glycemic events in critically ill patients.
Collapse
Affiliation(s)
- Luc A Foubert
- 1 Department of Anesthesia and Critical Care Medicine, Onze Lieve Vrouw Hospital , Aalst, Belgium
| | | | | | | | | |
Collapse
|
15
|
Lheureux O, Preiser JC. Year in review 2013: Critical Care--metabolism. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2014; 18:571. [PMID: 25672544 PMCID: PMC4330939 DOI: 10.1186/s13054-014-0571-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Novel insights into the metabolic alterations of critical illness, including new findings on association between blood glucose at admission and poor outcome, were published in Critical Care in 2013. The role of diabetic status in the relation of the three domains of glycemic control (hyperglycemia, hypoglycemia, and glycemic variability) was clarified: the association between mean glucose, high glucose variability, and ICU mortality was stronger in the non-diabetic than in diabetic patients. Improvements in the understanding of pathophysiological mechanisms of stress hyperglycemia were presented. Novel developments for the management of glucose control included automated closed-loop algorithms based on subcutaneous glucose measurements and microdialysis techniques. In the field of obesity, some new hypotheses that could explain the ‘obesity paradox’ were released, and a role of adipose tissue in the response to stress was suggested by the time course of adipocyte fatty-acid binding protein concentrations. In the field of nutrition, beneficial immunological effects have been associated with early enteral nutrition. Early enteral nutrition was significantly associated with potential beneficial effects on the phenotype of lymphocytes. Uncertainties regarding the potential benefits of small intestine feeding compared with gastric feeding were further investigated. No significant differences were observed between the nasogastric and nasojejunal feeding groups in the incidence of mortality, tracheal aspiration, or exacerbation of pain. The major risk factors to develop diarrhea in the ICU were described. Finally, the understanding of disorders associated with trauma and potential benefits of blood acidification was improved by new experimental findings.
Collapse
|
16
|
Wilinska ME, Hovorka R. Glucose control in the intensive care unit by use of continuous glucose monitoring: what level of measurement error is acceptable? Clin Chem 2014; 60:1500-9. [PMID: 25294923 DOI: 10.1373/clinchem.2014.225326] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Accuracy and frequency of glucose measurement is essential to achieve safe and efficacious glucose control in the intensive care unit. Emerging continuous glucose monitors provide frequent measurements, trending information, and alarms. The objective of this study was to establish the level of accuracy of continuous glucose monitoring (CGM) associated with safe and efficacious glucose control in the intensive care unit. METHODS We evaluated 3 established glucose control protocols [Yale, University of Washington, and Normoglycemia in Intensive Care Evaluation and Surviving Using Glucose Algorithm Regulation (NICE-SUGAR)] by use of computer simulations. Insulin delivery was informed by intermittent blood glucose (BG) measurements or CGM levels with an increasing level of measurement error. Measures of glucose control included mean glucose, glucose variability, proportion of time glucose was in target range, and hypoglycemia episodes. RESULTS Apart from the Washington protocol, CGM with mean absolute relative deviation (MARD) ≤ 15% resulted in similar mean glucose as with the use of intermittent BG measurements. Glucose variability was also similar between CGM and BG-informed protocols. Frequency and duration of hypoglycemia were not worse by use of CGM with MARD ≤ 10%. Measures of glucose control varied more between protocols than at different levels of the CGM error. CONCLUSIONS The efficacy of CGM-informed and BG-informed commonly used glucose protocols is similar, but the risk of hypoglycemia may be reduced by use of CGM with MARD ≤ 10%. Protocol choice has greater influence on glucose control measures than the glucose measurement method.
Collapse
Affiliation(s)
- Malgorzata E Wilinska
- Wellcome Trust-MRC Institute of Metabolic Science and Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Roman Hovorka
- Wellcome Trust-MRC Institute of Metabolic Science and Department of Paediatrics, University of Cambridge, Cambridge, UK.
| |
Collapse
|
17
|
Schierenbeck F, Wallin M, Franco-Cereceda A, Liska J. Evaluation of intravascular microdialysis for continuous blood glucose monitoring in hypoglycemia: an animal model. J Diabetes Sci Technol 2014; 8:839-44. [PMID: 24876424 PMCID: PMC4764236 DOI: 10.1177/1932296814532206] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
We have previously shown that intravascular microdialysis in a central vein is an accurate method for continuous glucose monitoring in patients undergoing cardiac surgery. However, no hypoglycemia occurred in our earlier studies, prompting further evaluation of the accuracy of intravascular microdialysis in the hypoglycemic range. Thus, this animal study was performed. A porcine model was developed; hypoglycemia was induced using insulin injections. The pigs were monitored with intravascular microdialysis integrated in a triple-lumen central venous catheter. As reference, venous blood gas samples were taken every 5 minutes and analyzed in a blood gas analyzer. Ethical permission for the animal experiments was obtained from the Stockholm Regional Ethical Committee, reference no N397/09. A total of 213 paired samples were obtained for analysis, and 126 (59.2%) of these were in the hypoglycemic range (<74 mg/dl). Using Clarke error grid analysis, 100% of the paired samples were in region AB and 99% in region A. The ISO standard (ISO15197) was met. Bland-Altman analysis showed bias (mean difference) ± limits of agreement was -0.18 ± 16.2 mg/dl. No influence from glucose infusions was seen. The microdialysis monitoring system was found to be very responsive in rapid changes in blood glucose concentration. This study shows that intravascular microdialysis in a central vein is an accurate method for continuous glucose monitoring in hypoglycemia in a porcine experimental model. Furthermore, the system was not influenced by glucose administration and was found to be responsive in rapid blood glucose fluctuations.
Collapse
Affiliation(s)
- Fanny Schierenbeck
- Section of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Mats Wallin
- Department of Physiology and Pharmacology, Karolinska Institutet and Maquet Critical Care AB, Solna, Sweden
| | - Anders Franco-Cereceda
- Section of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Jan Liska
- Section of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
18
|
Haluzik M, Mraz M, Kopecky P, Lips M, Svacina S. Glucose control in the ICU: is there a time for more ambitious targets again? J Diabetes Sci Technol 2014; 8:652-7. [PMID: 24876440 PMCID: PMC4764214 DOI: 10.1177/1932296814533847] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
During the last 2 decades, the treatment of hyperglycemia in critically ill patients has become one of the most discussed topics in the intensive medicine field. The initial data suggesting significant benefit of normalization of blood glucose levels in critically ill patients using intensive intravenous insulin therapy have been challenged or even neglected by some later studies. At the moment, the need for glucose control in critically ill patients is generally accepted yet the target glucose values are still the subject of ongoing debates. In this review, we summarize the current data on the benefits and risks of tight glucose control in critically ill patients focusing on the novel technological approaches including continuous glucose monitoring and its combination with computer-based algorithms that might help to overcome some of the hurdles of tight glucose control. Since increased risk of hypoglycemia appears to be the major obstacle of tight glucose control, we try to put forward novel approaches that may help to achieve optimal glucose control with low risk of hypoglycemia. If such approaches can be implemented in real-world practice the entire concept of tight glucose control may need to be revisited.
Collapse
Affiliation(s)
- Martin Haluzik
- 3rd Department of Medicine, Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - Milos Mraz
- 3rd Department of Medicine, Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - Petr Kopecky
- Department of Anaesthesia, Resuscitation and Intensive Medicine, Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - Michal Lips
- Department of Anaesthesia, Resuscitation and Intensive Medicine, Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - Stepan Svacina
- 3rd Department of Medicine, Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic
| |
Collapse
|
19
|
Wernerman J, Desaive T, Finfer S, Foubert L, Furnary A, Holzinger U, Hovorka R, Joseph J, Kosiborod M, Krinsley J, Mesotten D, Nasraway S, Rooyackers O, Schultz MJ, Van Herpe T, Vigersky RA, Preiser JC. Continuous glucose control in the ICU: report of a 2013 round table meeting. Crit Care 2014; 18:226. [PMID: 25041718 PMCID: PMC4078395 DOI: 10.1186/cc13921] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Jan Wernerman
- Department of Anesthesiology and Intensive Care Medicine, K32, Karolinska University Hospital, Stockholm, Huddinge 14186, Sweden
| | - Thomas Desaive
- GIGA - Cardiovascular Sciences, University of Liege, Institute of Physics, B5, Allee du 6 aout, 17, Liege 4000, Belgium
| | - Simon Finfer
- The George Institute for Global Health and Royal North Shore Hospital, University of Sydney, St Leonards, Sydney, NSW 2065, Australia
| | - Luc Foubert
- Department of Anesthesia and Intensive Care Medicine, OLV Clinic, Aalst 9300, Belgium
| | - Anthony Furnary
- Starr-Wood Cardiac Group, 9155 SW Barnes Road, Portland, OR 97225-6629, USA
| | - Ulrike Holzinger
- Department of Medicine III - Division of Gastroenterology and Hepatology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria
| | - Roman Hovorka
- University of Cambridge Metabolic Research Laboratories, Level 4, Wellcome trust MRC Institute of Metabolic Science, Box 289, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - Jeffrey Joseph
- Jefferson Artificial Pancreas Center and Anesthesiology Program for Translational Research, Department of Anesthesiology, Jefferson Medical College of Thomas Jefferson University, 1020 Walnut Street, Philadelphia, PA 19107, USA
| | - Mikhail Kosiborod
- Saint-Luke’s Mid America Heart Institute, University of Missouri - Kansas City, 4401 Wornall Road, Kansas City, MO 64111, USA
| | - James Krinsley
- Division of Critical Care, Stamford Hospital and Columbia University College of Physicians and Surgeons, 30 Shelburne Road, Stamford, CT 06904, USA
| | - Dieter Mesotten
- Department of Intensive Care Medicine, University Hospitals Leuven, Herestraat 49, Leuven B-3000, Belgium
| | - Stanley Nasraway
- Surgical Intensive Care Units, Tufts Medical Center, 800 Washington Street, NEMC 4360, Boston, MA 02111, USA
| | - Olav Rooyackers
- Anesthesiology and Intensive Care Clinic, Karolinska Institute and University Hospital, Huddinge 14186, Sweden
| | - Marcus J Schultz
- Department of Intensive Care Medicine, Academic Medical Center at the University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
| | - Tom Van Herpe
- Department of Intensive Care Medicine, University Hospitals Leuven, Herestraat 49, Leuven B-3000, Belgium
- Department of Electrical Engineering (STADIUS) - iMinds Future Health Department, Katholieke Universiteit Leuven, Leuven, Heverlee B-3001, Belgium
| | - Robert A Vigersky
- Diabetes Institute, Walter Reed National Military Medical Center, Bethesda, MD 20895, USA
| | - Jean-Charles Preiser
- Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, 808 route de Lennik, Brussels 1070, Belgium
| |
Collapse
|
20
|
Scuffi C. Interstitium versus Blood Equilibrium in Glucose Concentration and its Impact on Subcutaneous Continuous Glucose Monitoring Systems. EUROPEAN ENDOCRINOLOGY 2014; 10:36-42. [PMID: 29872462 PMCID: PMC5983095 DOI: 10.17925/ee.2014.10.01.36] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 02/13/2014] [Indexed: 12/18/2022]
Abstract
The relationship between both interstitial and blood glucose remains a debated topic, on which there is still no consensus. The experimental evidence suggests that blood and interstitial fluid glucose levels are correlated by a kinetic equilibrium, which as a consequence has a time and magnitude gradient in glucose concentration between blood and interstitium. Furthermore, this equilibrium can be perturbed by several physiological effects (such as foreign body response, wound-healing effect, etc.), with a consequent reduction of interstitial fluid glucose versus blood glucose correlation. In the present study, the impact of operating in the interstitium on continuous glucose monitoring systems (CGMs) will be discussed in depth, both for the application of CGMs in the management of diabetes and in other critical areas, such as tight glycaemic control in critically ill patients.
Collapse
Affiliation(s)
- Cosimo Scuffi
- Scientist, Scientific and Technology Affairs Department, A. Menarini Diagnostics, Florence, Italy
| |
Collapse
|
21
|
Umbrello M, Salice V, Spanu P, Formenti P, Barassi A, Melzi d'Eril GV, Iapichino G. Performance assessment of a glucose control protocol in septic patients with an automated intermittent plasma glucose monitoring device. Clin Nutr 2013; 33:867-71. [PMID: 24169498 DOI: 10.1016/j.clnu.2013.10.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 10/09/2013] [Accepted: 10/10/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND & AIMS The optimal level and modality of glucose control in critically ill patients is still debated. A protocolized approach and the use of nearly-continuous technologies are recommended to manage hyperglycemia, hypoglycemia and glycemic variability. We recently proposed a pato-physiology-based glucose control protocol which takes into account patient glucose/carbohydrate intake and insulin resistance. Aim of the present investigation was to assess the performance of our protocol with an automated intermittent plasma glucose monitoring device (OptiScanner™ 5000). METHODS OptiScanner™ was used in 6 septic patients, providing glucose measurement every 15' from a side-port of an indwelling central venous catheter. Target level of glucose was 80-150 mg/dL. Insulin infusion and kcal with nutritional support were also recorded. RESULTS 6 septic patients were studied for 319 h (1277 measurements); 58 [45-65] hours for each patient (measurements/patient: 231 [172-265]). Blood glucose was at target for 93 [90-98]% of study time. Mean plasma glucose was 126 ± 11 mg/dL. Only 3 hypoglycemic episodes (78, 78, 69 mg/dL) were recorded. Glucose variability was limited: plasma glucose coefficient of variation was 11.7 ± 4.0% and plasma glucose standard deviation was 14.3 ± 5.5 mg/dL. CONCLUSIONS The local glucose control protocol achieved satisfactory glucose control in septic patients along with a high degree of safeness. Automated intermittent plasma glucose monitoring seemed useful to assess the performance of the protocol.
Collapse
Affiliation(s)
- M Umbrello
- Unità Operativa di Anestesia e Rianimazione, Azienda Ospedaliera San Paolo - Polo Universitario, Italy.
| | - V Salice
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Italy
| | - P Spanu
- Unità Operativa di Anestesia e Rianimazione, Azienda Ospedaliera San Paolo - Polo Universitario, Italy
| | - P Formenti
- Unità Operativa di Anestesia e Rianimazione, Azienda Ospedaliera San Paolo - Polo Universitario, Italy
| | - A Barassi
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Italy
| | - G V Melzi d'Eril
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Italy
| | - G Iapichino
- Unità Operativa di Anestesia e Rianimazione, Azienda Ospedaliera San Paolo - Polo Universitario, Italy; Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Italy
| |
Collapse
|
22
|
Mesotten D. Continuous glucose sensors for glycaemic control in the ICU: have we arrived? CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2013; 17:1004. [PMID: 24103553 PMCID: PMC4056657 DOI: 10.1186/cc12804] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Dr Blixt and colleagues show in an elegant pilot study that the continuous measurement of glucose in venous blood by microdialysis in a central venous catheter is feasible in critically ill patients. The performance of this type of continuous glucose monitoring device equals the performance of the commonly used handheld blood glucose meters. But are we, as ICU physicians and nurses, now ready to implement such continuous blood glucose sensors into the daily practice of the ICU? The only yardstick to this is "are these devices truly helping us ...in our critically ill patients".
Collapse
|