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Wang Q, Molinero-Fernandez Á, Wei Q, Xuan X, Konradsson-Geuken Å, Cuartero M, Crespo GA. Intradermal Lactate Monitoring Based on a Microneedle Sensor Patch for Enhanced In Vivo Accuracy. ACS Sens 2024; 9:3115-3125. [PMID: 38778463 PMCID: PMC11217941 DOI: 10.1021/acssensors.4c00337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 05/10/2024] [Accepted: 05/15/2024] [Indexed: 05/25/2024]
Abstract
Lactate is an important diagnostic and prognostic biomarker of several human pathological conditions, such as sepsis, malaria, and dengue fever. Unfortunately, due to the lack of reliable analytical decentralized platforms, the determination of lactate yet relies on discrete blood-based assays, which are invasive and inefficient and may cause tension and pain in the patient. Herein, we demonstrate the potential of a fully integrated microneedle (MN) sensing system for the minimally invasive transdermal detection of lactate in an interstitial fluid (ISF). The originality of this analytical technology relies on: (i) a strategy to provide a uniform coating of a doped polymer-based membrane as a diffusion-limiting layer on the MN structure, optimized to perform full-range lactate detection in the ISF (linear range of response: 0.25-35 mM, 30 s assay time, 8 h operation), (ii) double validation of ex vivo and in vivo results based on ISF and blood measurements in rats, (iii) monitoring of lactate level fluctuations under the administration of anesthesia to mimic bedside clinical scenarios, and (iv) in-house design and fabrication of a fully integrated and portable sensing device in the form of a wearable patch including a custom application and user-friendly interface in a smartphone for the rapid, routine, continuous, and real-time lactate monitoring. The main analytical merits of the lactate MN sensor include appropriate selectivity, reversibility, stability, and durability by using a two-electrode amperometric readout. The ex-vivo testing of the MN patch of preconditioned rat skin pieces and euthanized rats successfully demonstrated the accuracy in measuring lactate levels. The in vivo measurements suggested the existence of a positive correlation between ISF and blood lactate when a lag time of 10 min is considered (Pearson's coefficient = 0.85, mean difference = 0.08 mM). The developed MN-based platform offers distinct advantages over noncontinuous blood sampling in a wide range of contexts, especially where access to laboratory services is limited or blood sampling is not suitable. Implementation of the wearable patch in healthcare could envision personalized medicine in a variety of clinical settings.
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Affiliation(s)
- Qianyu Wang
- Department
of Chemistry, KTH Royal Institute of Technology, Teknikringen 30, SE-114 28 Stockholm, Sweden
| | - Águeda Molinero-Fernandez
- Department
of Chemistry, KTH Royal Institute of Technology, Teknikringen 30, SE-114 28 Stockholm, Sweden
- UCAM-SENS,
Universidad Católica San Antonio de Murcia, UCAM HiTech, Avda. Andres Hernandez Ros 1, 30107 Murcia, Spain
| | - Qikun Wei
- Department
of Chemistry, KTH Royal Institute of Technology, Teknikringen 30, SE-114 28 Stockholm, Sweden
| | - Xing Xuan
- Department
of Chemistry, KTH Royal Institute of Technology, Teknikringen 30, SE-114 28 Stockholm, Sweden
- UCAM-SENS,
Universidad Católica San Antonio de Murcia, UCAM HiTech, Avda. Andres Hernandez Ros 1, 30107 Murcia, Spain
| | - Åsa Konradsson-Geuken
- Section
of Neuropharmacology and Addiction Research, Department of Pharmaceutical
Biosciences, Uppsala University, SE-751 05 Uppsala, Sweden
| | - María Cuartero
- Department
of Chemistry, KTH Royal Institute of Technology, Teknikringen 30, SE-114 28 Stockholm, Sweden
- UCAM-SENS,
Universidad Católica San Antonio de Murcia, UCAM HiTech, Avda. Andres Hernandez Ros 1, 30107 Murcia, Spain
| | - Gastón A. Crespo
- Department
of Chemistry, KTH Royal Institute of Technology, Teknikringen 30, SE-114 28 Stockholm, Sweden
- UCAM-SENS,
Universidad Católica San Antonio de Murcia, UCAM HiTech, Avda. Andres Hernandez Ros 1, 30107 Murcia, Spain
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Microdialysis techniques and microdialysis-based patient-near diagnostics. Anal Bioanal Chem 2022; 414:3165-3175. [PMID: 35028692 DOI: 10.1007/s00216-021-03830-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/17/2021] [Accepted: 12/03/2021] [Indexed: 01/04/2023]
Abstract
This article will debate the usefulness of POCT measurements and the contribution microdialysis can make to generating valuable information. A particular theme will be the rarely considered difference between ex vivo sampling, which typically generates only a static measure of concentration, and in vivo measurements that are subject to dynamic changes due to mass transfer. Those dynamic changes provide information about the patients' physiological state.
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Continuous Lactate Measurement Devices and Implications for Critical Care: A Literature Review. Crit Care Nurs Q 2021; 43:269-273. [PMID: 32433067 DOI: 10.1097/cnq.0000000000000311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The aim of this article is to review the literature on lactate measurements in critical care and the current devices used to measure noninvasively and invasively. Lactate measurements are currently being used as a way to measure the severity of sepsis. Intravascular and subcutaneous devices are some of the ways that these measurements can be continuously gathered as well as point-of-care blood tests. New devices that are being currently used with athletes can measure lactate noninvasively. As the advance of technology continues to move at a fast speed, an evaluation of literature is needed to assess the continued support of lactate and the ability to move to noninvasive devices in critical care. A literature search was conducted in February 2020, using PubMed, CINAHL, MEDLINE, and Cochrane databases. There remains support for the use of lactate and continuous lactate monitoring; however, currently, noninvasive devices are not available for the critical care environment. There are invasive techniques that are being used to measure lactate continuously in critical care and are beneficial for the cardiac surgery population. The review of the literature on continuous lactate measurements produced evidence that supports prediction of morbidity and mortality. There are no current noninvasive lactate measurement devices that can be used in critical care, but they are being currently used in the athletic community. Invasive continuous lactate measurement devices are currently being used and beneficial.
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Abstract
The basis of all metabolic processes in the human body is the production and metabolism of carriers of energy. Lactate is the end-product of anaerobic glycolysis. Lactate can serve as a substrate for gluconeogenesis and as an oxidation substrate. Hyperlactatemia can be detected as the result of a multitude of acute events (e.g. shock, sepsis, cardiac arrest, trauma, seizure, ischemia, diabetic ketoacidosis, thiamine deficiency, liver failure and intoxication). Hyperlactatemia can be associated with increased mortality, therefore in emergency medicine the search for the cause of hyperlactatemia is just as important as an effective causal treatment. Repetitive measurements of lactate are components of several treatment algorithms as observation of the dynamic development of blood lactate concentrations can help to make a better assessment of the acute medical condition of the patient and to evaluate the effectiveness of the measures undertaken.
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Continuous lactate monitoring in critically ill patients using microdialysis. Anaesth Crit Care Pain Med 2020; 39:513-517. [PMID: 32659456 DOI: 10.1016/j.accpm.2020.05.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 05/13/2020] [Accepted: 05/29/2020] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Blood lactate is a strong predictor of mortality in critically ill patients. Its monitoring implies repeated measurements. The EIRUS™ system (Maquet Critical Care AB, 17154, Solna, Sweden) is a new device allowing continuous lactate monitoring by intravascular micro dialysis. The present study aimed at assessing the accuracy of the EIRUS™ system in critically ill patients with circulatory failure. METHODS An observational cohort study was conducted in Nîmes University Hospital. Eligible patients were those with circulatory failure in which a specific central venous access was put in place by the physician in charge, allowing continuous lactate measurement by the EIRUS™ system. Lactate measurements obtained by the system were compared to lactate from arterial blood samples at H4 and H8 from the calibration, during the first 48hours of shock. RESULTS In all, 28 patients were included providing 244 pairs of measures. The Bland-Altman analysis showed a bootstrapped mean bias at H4 of 0.05 and 95% limits of agreement of -0.9 to 1.0mmol/L. At H8 the mean bias was 0.06 and 95% limits of agreement -1.1 to 1.2mmol/L. The global trend agreement [95% CI] for a pre-specified arbitrary threshold of 1mmol/L, defining clinically significant variations, between H0 and H4 and H4 and H8 was 91.6% [85.1; 95.9] and 89.5% [82.3; 94.4], respectively. CONCLUSION The EIRUS™ device provided an overall accurate measurement of lactate in critically ill patients with circulatory failure. Detection of lactate variations over time is less precise and technical issues may limit its clinical use.
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Yan J, van Smeden L, Merkx M, Zijlstra P, Prins MWJ. Continuous Small-Molecule Monitoring with a Digital Single-Particle Switch. ACS Sens 2020; 5:1168-1176. [PMID: 32189498 PMCID: PMC8177406 DOI: 10.1021/acssensors.0c00220] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
![]()
The
ability to continuously measure concentrations of small molecules
is important for biomedical, environmental, and industrial monitoring.
However, because of their low molecular mass, it is difficult to quantify
concentrations of such molecules, particularly at low concentrations.
Here, we describe a small-molecule sensor that is generalizable, sensitive,
specific, reversible, and suited for continuous monitoring over long
durations. The sensor consists of particles attached to a sensing
surface via a double-stranded DNA tether. The particles transiently
bind to the sensing surface via single-molecular affinity interactions,
and the transient binding is optically detected as digital binding
events via the Brownian motion of the particles. The rate of binding
events decreases with increasing analyte concentration because analyte
molecules inhibit binding of the tethered particle to the surface.
The sensor enables continuous measurements of analyte concentrations
because of the reversibility of the intermolecular bonds and digital
read-out of particle motion. We show results for the monitoring of
short single-stranded DNA sequences and creatinine, a small-molecule
biomarker (113 Da) for kidney function, demonstrating a temporal resolution
of a few minutes. The precision of the sensor is determined by the
statistics of the digital switching events, which means that the precision
is tunable by the number of particles and the measurement time.
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Affiliation(s)
- Junhong Yan
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven 5612 AZ, The Netherlands
- Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, Eindhoven 5612 AZ, The Netherlands
| | - Laura van Smeden
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven 5612 AZ, The Netherlands
- Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, Eindhoven 5612 AZ, The Netherlands
| | - Maarten Merkx
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven 5612 AZ, The Netherlands
- Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, Eindhoven 5612 AZ, The Netherlands
| | - Peter Zijlstra
- Department of Applied Physics, Eindhoven University of Technology, Eindhoven 5612 AZ, The Netherlands
- Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, Eindhoven 5612 AZ, The Netherlands
| | - Menno W. J. Prins
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven 5612 AZ, The Netherlands
- Department of Applied Physics, Eindhoven University of Technology, Eindhoven 5612 AZ, The Netherlands
- Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, Eindhoven 5612 AZ, The Netherlands
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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.
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Dynamic properties of glucose complexity during the course of critical illness: a pilot study. J Clin Monit Comput 2020; 34:361-370. [PMID: 30888595 DOI: 10.1007/s10877-019-00299-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 03/13/2019] [Indexed: 10/27/2022]
Abstract
Methods to control the blood glucose (BG) levels of patients in intensive care units (ICU) improve the outcomes. The development of continuous BG levels monitoring devices has also permitted to optimize these processes. Recently it was shown that a complexity loss of the BG signal is linked to poor clinical outcomes. Thus, it becomes essential to decipher this relation to design efficient BG level control methods. In previous studies the BG signal complexity was calculated as a single index for the whole ICU stay. Although, these approaches did not grasp the potential variability of the BG signal complexity. Therefore, we setup this pilot study using a continuous monitoring of central venous BG levels in ten critically ill patients (EIRUS platform, Maquet Critical CARE AB, Solna, Sweden). Data were processed and the complexity was assessed by the detrended fluctuation analysis and multiscale entropy (MSE) methods. Finally, recordings were split into 24 h overlapping intervals and a MSE analysis was applied to each of them. The MSE analysis on time intervals revealed an entropy variation and allowed periodic BG signal complexity assessments. To highlight differences of MSE between each time interval we calculated the MSE complexity index defined as the area under the curve. This new approach could pave the way to future studies exploring new strategies aimed at restoring blood glucose complexity during the ICU stay.
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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.
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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
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10
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Gouëzel C, Lorne E, Bonnet V, Fradin S, Saplacan V, Gérard JL, Hanouz JL, Fellahi JL, Fischer MO. Assessment of changes in lactate concentration with intravascular microdialysis during high-risk cardiac surgery using the trend interchangeability method. Br J Anaesth 2019; 119:1110-1117. [PMID: 29028910 DOI: 10.1093/bja/aex338] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2017] [Indexed: 01/10/2023] Open
Abstract
Background Blood lactate is a strong predictor of mortality, and repeated blood lactate assays are recommended during surgery in high-risk patients. We hypothesized that the use of intravascular microdialysis incorporated in a central venous catheter would be interchangeable with the reference blood gas technique to monitor changes in blood lactate. Methods Microdialysis and central venous blood lactate measurements were recorded simultaneously 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 lactate measurements were evaluated with a four-quadrant plot and trend interchangeability method (TIM). Results In the 23 patients analysed, the central venous catheter was used as part of standard care, with no complications. The correlation coefficient for absolute values ( n =104) was 0.96 ( P <0.0001). The bias, precision, and limits of agreement were -0.19, 0.51, and -1.20 to 0.82 mmol litre -1 , respectively. The concordance rate for changes in blood lactate measurements ( n =80) was 94% with the four-quadrant plot. In contrast, the TIM showed that 23 (29) changes in lactate measurements were not interpretable, and among the remaining 57 (71) interpretable changes, 18 (32) were interchangeable, 8 (14) were in the grey zone, and 31 (54) were not interchangeable. Conclusions Microdialysis with a central venous catheter appears to provide reliable absolute blood lactate values. Although changes in blood lactate measurements showed an excellent concordance rate, changes between the two methods were poorly interchangeable with the TIM. Clinical trial registration NCT02296593.
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Affiliation(s)
- C Gouëzel
- Department of Anaesthesia and Intensive Care Medicine, Caen University Hospital, Avenue de la Côte de Nacre, CS 30001, F-14000 Caen, France
| | - E Lorne
- Anaesthesiology and Critical Care Department, Amiens University Medical Centre, avenue René Laennec, F-80054 Amiens, France.,INSERM U1088, Jules Verne University of Picardy, Centre Universitaire de Recherche en Santé (CURS), Chemin du Thil, F-80025 Amiens cedex, France
| | - V Bonnet
- Department of Anaesthesia and Intensive Care Medicine, Caen University Hospital, Avenue de la Côte de Nacre, CS 30001, F-14000 Caen, France
| | - S Fradin
- Department of Biology, Caen University Hospital, Avenue de la Côte de Nacre, CS 30001, F-14000 Caen, France
| | - V Saplacan
- Cardiac Surgery, Caen University Hospital, Avenue de la Côte de Nacre, CS 30001, F-14000 Caen, France
| | - J-L Gérard
- Department of Anaesthesia and Intensive Care Medicine, Caen University Hospital, Avenue de la Côte de Nacre, CS 30001, F-14000 Caen, France
| | - J-L Hanouz
- Department of Anaesthesia and Intensive Care Medicine, Caen University Hospital, Avenue de la Côte de Nacre, CS 30001, F-14000 Caen, France.,EA 4650, Caen Normandy University, Esplanade de la Paix, CS 14 032, F-14000 Caen, France
| | - J-L Fellahi
- Department of Anaesthesia and Intensive Care Medicine, Hôpital cardiologique Louis Pradel, Avenue du Doyen Lepine, F-69 677 Lyon, France.,Faculty of Medicine, University of Lyon 1 Claude Bernard, F-69 008 Lyon, France
| | - M-O Fischer
- Department of Anaesthesia and Intensive Care Medicine, Caen University Hospital, Avenue de la Côte de Nacre, CS 30001, F-14000 Caen, France.,EA 4650, Caen Normandy University, Esplanade de la Paix, CS 14 032, F-14000 Caen, France
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Lydon EC, Ko ER, Tsalik EL. The host response as a tool for infectious disease diagnosis and management. Expert Rev Mol Diagn 2018; 18:723-738. [PMID: 29939801 DOI: 10.1080/14737159.2018.1493378] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION A century of advances in infectious disease diagnosis and treatment changed the face of medicine. However, challenges continue to develop including multi-drug resistance, globalization that increases pandemic risks, and high mortality from severe infections. These challenges can be mitigated through improved diagnostics, and over the past decade, there has been a particular focus on the host response. Since this article was originally published in 2015, there have been significant developments in the field of host response diagnostics, warranting this updated review. Areas Covered: This review begins by discussing developments in single biomarkers and pauci-analyte biomarker panels. It then delves into 'omics, an area where there has been truly exciting progress. Specifically, progress has been made in sepsis diagnosis and prognosis; differentiating viral, bacterial, and fungal pathogen classes; pre-symptomatic diagnosis; and understanding disease-specific diagnostic challenges in tuberculosis, Lyme disease, and Ebola. Expert Commentary: As 'omics have become faster, more precise, and less expensive, the door has been opened for academic, industry, and government efforts to develop host-based infectious disease classifiers. While there are still obstacles to overcome, the chasm separating these scientific advances from the patient's bedside is shrinking.
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Affiliation(s)
- Emily C Lydon
- a Duke University School of Medicine , Duke University , Durham , NC , USA
| | - Emily R Ko
- b Duke Center for Applied Genomics & Precision Medicine, Department of Medicine , Duke University , Durham , NC , USA.,c Duke Regional Hospital, Department of Medicine , Duke University , Durham , NC , USA
| | - Ephraim L Tsalik
- b Duke Center for Applied Genomics & Precision Medicine, Department of Medicine , Duke University , Durham , NC , USA.,d Division of Infectious Diseases & International Health, Department of Medicine , Duke University , Durham , NC , USA.,e Emergency Medicine Service , Durham Veterans Affairs Health Care System , Durham , NC , USA
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12
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Mölström S, Nielsen TH, Andersen C, Nordström CH, Toft P. Bedside Monitoring of Cerebral Energy State During Cardiac Surgery—A Novel Approach Utilizing Intravenous Microdialysis. J Cardiothorac Vasc Anesth 2017; 31:1166-1173. [DOI: 10.1053/j.jvca.2016.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Indexed: 01/28/2023]
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14
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Lenkin PI, Smetkin AA, Hussain A, Lenkin AI, Paromov KV, Ushakov AA, Krygina MM, Kuzkov VV, Kirov MY. Continuous Monitoring of Lactate Using Intravascular Microdialysis in High-Risk Cardiac Surgery: A Prospective Observational Study. J Cardiothorac Vasc Anesth 2017; 31:37-44. [DOI: 10.1053/j.jvca.2016.04.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Indexed: 02/08/2023]
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15
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Righy Shinotsuka C, Brasseur A, Fagnoul D, So T, Vincent JL, Preiser JC. Manual versus Automated moNitoring Accuracy of GlucosE II (MANAGE II). Crit Care 2016; 20:380. [PMID: 27884157 PMCID: PMC5123350 DOI: 10.1186/s13054-016-1547-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 10/31/2016] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Intravascular continuous glucose monitoring (CGM) may facilitate glycemic control in the intensive care unit (ICU). We compared the accuracy of a CGM device (OptiScanner®) with a standard reference method. METHODS Adult patients who had blood glucose (BG) levels >150 mg/dl and required insertion of an arterial and central venous catheter were included. The OptiScanner® was inserted into a multiple-lumen central venous catheter. Patients were treated using a dynamic-scale insulin algorithm to achieve BG values between 80 and 150 mg/dl. The BG values measured by the OptiScanner® were plotted against BG values measured using a reference analyzer. The correlation between the BG values measured using the two methods and the clinical relevance of any differences were assessed using the coefficient of determination (r 2) and the Clarke error grid, respectively; bias was assessed by the mean absolute relative difference (MARD). Three different standards of glucose monitoring were used to assess accuracy. Glycemic control was assessed using the time in range (TIR). Six indices of glycemic variability were calculated. RESULTS The analysis included 929 paired samples from 88 patients, monitored for a total of 2584 hours. Reference BG values ranged between 60 and 484 mg/dl. The r 2 value was 0.89. The percentage of BG values within zones A and B of the Clarke error grid was 99.9%; the MARD was 7.7%. Using the ISO 15197 standard and Food and Drug Administration and consensus standards, respectively, 80.4% of measurements were within 15 mg/dl and 88.2% within 15% of reference values, 40% of measurements were within 7 mg/dl and 72.5% within 10% of reference values, and 65.2% of measurements were within 10 mg/dl and 82.7% within 12.5% of reference values. The TIR was slightly lower with the OptiScanner® than with the reference method. The J-index, standard deviation and maximal glucose change were the indices of glycemic variability least affected by the measurement device. CONCLUSIONS Based on the MARD, the performance of the OptiScanner® is adequate for use in ICU patients. Because recent standards for accuracy were not met, the OptiScanner® should not be used as a sole monitor. The assessment of glycemic variability is influenced by the time interval between BG determinations. TRIAL REGISTRATION Clinicaltrials.gov NCT01720381 . Registered 31 October 2012.
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Affiliation(s)
- Cláudia Righy Shinotsuka
- Department of Intensive Care, Erasme University Hospital, Université libre de Bruxelles, 808 route de Lennik, Brussels, B-1070 Belgium
| | - Alexandre Brasseur
- Department of Intensive Care, Erasme University Hospital, Université libre de Bruxelles, 808 route de Lennik, Brussels, B-1070 Belgium
| | - David Fagnoul
- Department of Intensive Care, Erasme University Hospital, Université libre de Bruxelles, 808 route de Lennik, Brussels, B-1070 Belgium
| | | | - Jean-Louis Vincent
- Department of Intensive Care, Erasme University Hospital, Université libre de Bruxelles, 808 route de Lennik, Brussels, B-1070 Belgium
| | - Jean-Charles Preiser
- Department of Intensive Care, Erasme University Hospital, Université libre de Bruxelles, 808 route de Lennik, Brussels, B-1070 Belgium
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Liasis L, Malietzis G, Galyfos G, Athanasiou T, Papaconstantinou HT, Sigala F, Zografos G, Filis K. The emerging role of microdialysis in diabetic patients undergoing amputation for limb ischemia. Wound Repair Regen 2016; 24:1073-1080. [PMID: 27733016 DOI: 10.1111/wrr.12492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 10/11/2016] [Indexed: 01/21/2023]
Abstract
Lower limb ischemia in diabetic patients is a result of macro- and microcirculation dysfunction. Diabetic patients undergoing limb amputation carry high mortality and morbidity rates, and decision making concerning the level of amputation is critical. Aim of this study is to evaluate a novel microdialysis technique to monitor tissue microcirculation preoperatively and predict the success of limb amputation in such patients. Overall, 165 patients with type 2 diabetes mellitus undergoing lower limb amputation were enrolled. A microdialysis catheter was placed preoperatively at the level of the intended flap for the stump reconstruction, and the levels of glucose, glycerol, lactate and pyruvate were measured for 24 consecutive hours. Patients were then amputated and monitored for 30 days regarding the outcome of amputation. Failure of amputation was defined as delayed healing or stump ischemia. Patients were divided into two groups based on the success of amputation. There was no difference between the two groups regarding gender, ASA score, body mass index, comorbidities, diagnostic modality used, level of amputation, as well as glucose, glycerol, and pyruvate levels. However, local concentrations of lactate were significantly different between the two groups and lactate/pyruvate (L/P) ratio was independently associated with failed amputation (threshold defined at 25.35). Elevated preoperative tissue L/P ratio is independently associated with worse outcomes in diabetic patients undergoing limb amputation. Therefore, preoperative tissue L/P ratio could be used as a predicting tool for limb amputation's outcome, although more clinical data are needed to provide safer conclusions.
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Affiliation(s)
- Lampros Liasis
- Department of Surgery, Northwick Park Hospital, Watford Road, Harrow, London, United Kingdom.,1st Propaedeutic Department of Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece
| | - George Malietzis
- Department of Surgery and Cancer, Imperial College, Paddington, London, United Kingdom
| | - George Galyfos
- 1st Propaedeutic Department of Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College, Paddington, London, United Kingdom
| | | | - Fragiska Sigala
- 1st Propaedeutic Department of Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece
| | - Georgios Zografos
- 1st Propaedeutic Department of Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece
| | - Konstantinos Filis
- 1st Propaedeutic Department of Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece
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Rapid assessment of shock in a nonhuman primate model of uncontrolled hemorrhage: Association of traditional and nontraditional vital signs to mortality risk. J Trauma Acute Care Surg 2016; 80:610-6. [PMID: 26808041 DOI: 10.1097/ta.0000000000000963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Heart rate (HR), systolic blood pressure (SBP) and mean arterial pressure (MAP) are traditionally used to guide patient triage and resuscitation; however, they correlate poorly to shock severity. Therefore, improved acute diagnostic capabilities are needed. Here, we correlated acute alterations in tissue oxygen saturation (StO2) and end-tidal carbon dioxide (ETCO2) to mortality in a rhesus macaque model of uncontrolled hemorrhage. METHODS Uncontrolled hemorrhage was induced in anesthetized rhesus macaques by a laparoscopic 60% left-lobe hepatectomy (T = 0 minute). StO2, ETCO2, HR, as well as invasive SBP and MAP were continuously monitored through T = 480 minutes. At T = 120 minutes, bleeding was surgically controlled, and blood loss was quantified. Data analyses compared nonsurvivors (expired before T = 480 minutes, n = 5) with survivors (survived to T = 480 minutes, n = 11) using repeated-measures analysis of variance with Bonferroni correction. All p < 0.05 was considered statistically significant. Results were reported as mean ± SEM. RESULTS Baseline values were equivalent between groups for each parameter. In nonsurvivors versus survivors at T = 5 minutes, StO2 (55% ± 10% vs. 78% ± 3%, p = 0.02) and ETCO2 (15 ± 2 vs. 25 ± 2 mm Hg, p = 0.0005) were lower, while MAP (18 ± 1 vs. 23 ± 2 mm Hg, p = 0.2), SBP (26 ± 2 vs. 34 ± 3 mm Hg, p = 0.4), and HR (104 ± 13 vs. 105 ± 6 beats/min, p = 0.3) were similar. Association of values over T = 5-30 minutes to mortality demonstrated StO2 and ETCO2 equivalency with a significant group effect (p ≤ 0.009 for each parameter; R(2) = 0.92 and R(2) = 0.90, respectively). MAP and SBP associated with mortality later into the shock period (p < 0.04 for each parameter; R(2) = 0.91 and R(2) = 0.89, respectively), while HR yielded the lowest association (p = 0.8, R(2) = 0.83). CONCLUSION Acute alterations in StO2 and ETCO2 strongly associated with mortality and preceded those of traditional vital signs. The continuous, noninvasive aspects of Food and Drug Administration-approved StO2 and ETCO2 monitoring devices provide logistical benefits over other methodologies and thus warrant further investigation.
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18
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Jakobsen R, Halfeld Nielsen T, Granfeldt A, Toft P, Nordström CH. A technique for continuous bedside monitoring of global cerebral energy state. Intensive Care Med Exp 2016; 4:3. [PMID: 26791144 PMCID: PMC4720625 DOI: 10.1186/s40635-016-0077-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 01/11/2016] [Indexed: 12/14/2022] Open
Abstract
Background Cerebral cytoplasmatic redox state is a sensitive indicator of cerebral oxidative metabolism and is conventionally evaluated from the extracellular lactate/pyruvate (LP) ratio. In the present experimental study of global cerebral ischemia induced by hemorrhagic shock, we investigate whether the LP ratio obtained from microdialysis of cerebral venous blood may be used as a surrogate marker of global cerebral energy state. Methods Six female pigs were anesthetized and vital parameters were recorded. Microdialysis catheters were placed in the left parietal lobe, the superior sagittal sinus, and the femoral artery. Hemorrhagic shock was achieved by bleeding the animals to a mean arterial pressure (MAP) of approximately 40 mmHg and kept at a MAP of about 30–40 mmHg for 90 min. The animals were resuscitated with autologous whole blood followed by 3 h of observation. Results The LP ratio obtained from the intracerebral and intravenous catheters immediately increased during the period of hemorrhagic shock while the LP ratio in the arterial blood remained close to normal levels. At the end of the experiment, median LP ratio (interquartile range) obtained from the intracerebral, intravenous, and intra-arterial microdialysis catheters were 846 (243–1990), 309 (103–488), and 27 (21–31), respectively. There was a significant difference in the LP ratio obtained from the intravenous location and the intra-arterial location (P < 0.001). Conclusions During cerebral ischemia induced by severe hemorrhagic shock, intravascular microdialysis of the draining venous blood will exhibit changes of the LP ratio revealing the deterioration of global cerebral oxidative energy metabolism. In neurocritical care, this technique might be used to give information regarding global cerebral energy metabolism in addition to the regional information obtained from intracerebral microdialysis catheters. The technique might also be used to evaluate cerebral energy state in various critical care conditions when insertion of an intracerebral microdialysis catheter may be contraindicated, e.g., resuscitation after cardiac standstill, open-heart surgery, and multi-trauma.
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Affiliation(s)
- Rasmus Jakobsen
- Department of Anaesthesia and Intensive care, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark.
| | - Troels Halfeld Nielsen
- Department of Neurosurgery, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark.
| | - Asger Granfeldt
- Department of Anesthesiology, Regional Hospital of Randers, Skovlyvej 1, 8930, Randers NØ, Denmark.
| | - Palle Toft
- Department of Anaesthesia and Intensive care, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark.
| | - Carl-Henrik Nordström
- Department of Neurosurgery, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark.
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Hosmann A, Schober A, Gruber A, Sterz F, Testori C, Warenits A, Weihs W, Högler S, Scherer T, Janata A, Laggner A, Zeitlinger M. Cerebral and Peripheral Metabolism to Predict Successful Reperfusion After Cardiac Arrest in Rats: A Microdialysis Study. Neurocrit Care 2015; 24:283-93. [DOI: 10.1007/s12028-015-0214-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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20
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Joseph JI, Torjman MC, Strasma PJ. Vascular Glucose Sensor Symposium: Continuous Glucose Monitoring Systems (CGMS) for Hospitalized and Ambulatory Patients at Risk for Hyperglycemia, Hypoglycemia, and Glycemic Variability. J Diabetes Sci Technol 2015; 9:725-38. [PMID: 26078254 PMCID: PMC4525658 DOI: 10.1177/1932296815587938] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Hyperglycemia, hypoglycemia, and glycemic variability have been associated with increased morbidity, mortality, length of stay, and cost in a variety of critical care and non-critical care patient populations in the hospital. The results from prospective randomized clinical trials designed to determine the risks and benefits of intensive insulin therapy and tight glycemic control have been confusing; and at times conflicting. The limitations of point-of-care blood glucose (BG) monitoring in the hospital highlight the great clinical need for an automated real-time continuous glucose monitoring system (CGMS) that can accurately measure the concentration of glucose every few minutes. Automation and standardization of the glucose measurement process have the potential to significantly improve BG control, clinical outcome, safety and cost.
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Affiliation(s)
- Jeffrey I Joseph
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Marc C Torjman
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
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