Experience with the continuous glucose monitoring system in a medical intensive care unit.
Experience with the continuous glucose monitoring system in a medical intensive care unit.
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DOI：
10.1089/152091504774198034
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发表时间：
2004-06-01
影响因子：
5.4
通讯作者：
Inzucchi, Silvio E
中科院分区：
文献类型：
--
作者：
Goldberg, Philip A;Siegel, Mark D;Inzucchi, Silvio E
严格的血糖控制可改善危重患者的临床结局。然而，用于在重症监护室（ICU）中频繁监测血糖（BG）水平的实用工具有限。持续葡萄糖监测系统（CGMS，Medtronic MiniMed，Northridge，CA）目前已获批用于检测门诊糖尿病患者的血糖波动。在住院患者中从未仔细检查过该器械的使用。这项初步研究旨在调查CGMS在重症监护病房（MICU）危重患者中的准确性。高血糖风险受试者是从我们MICU收治的所有患者中招募的。CGMS传感器植入长达72小时。研究受试者佩戴1到5个连续传感器。每24 h记录4次或更多次标准毛细血管BG读数。所有配对的仪表-传感器（M-S）读数均用于CGMS校准和数据分析。22名MICU患者佩戴41个CGMS传感器，产生546个M-S BG对。总体而言，Pearson相关系数（r）为0.88，平均M-S差异为3.3 +/- 26.7 mg/dL（0.6 +/- 17.4%），平均绝对M-S差异为19.7 +/- 18.3 mg/dL（12.8 +/- 11.9%）。Clarke误差网格分析将98.7%的M-S对归类在“临床可接受”区域A和B内。CGMS有望用于危重患者。如果在更大规模的研究中得到验证，该设备可以作为一个有用的研究工具，用于研究ICU患者中高血糖（和严格的血糖控制）的作用。如果进一步开发为“实时”葡萄糖传感器，CGMS技术最终可以证明在ICU中的临床有用，通过减少护理工作量和/或通过提供即将发生的血糖波动的警报信号。
Strict glycemic control improves clinical outcomes in critically ill patients. However, practical tools for frequent monitoring of blood glucose (BG) levels in the intensive care unit (ICU) are limited. The Continuous Glucose Monitoring System (CGMS, Medtronic MiniMed, Northridge, CA) is currently approved for detecting glycemic excursions in outpatients with diabetes mellitus. The use of this device has never been carefully examined in the inpatient setting. This preliminary study was designed to investigate the accuracy of the CGMS in critically ill patients admitted to a medical ICU (MICU). Subjects at risk for hyperglycemia were recruited from among all patients admitted to our MICU. CGMS sensors were implanted for up to 72 h. Study subjects wore between one and five consecutive sensors. Four or more standard capillary BG readings were recorded per 24 h. All paired meter-sensor (M-S) readings were used both for CGMS calibration and for data analysis. Twenty-two MICU patients wore 41 CGMS sensors, yielding 546 M-S BG pairs. Overall, the Pearson correlation coefficient ( r ) was 0.88, with a mean M-S difference of 3.3 +/- 26.7 mg/dL (0.6 +/- 17.4%) and a mean absolute M-S difference of 19.7 +/- 18.3 mg/dL (12.8 +/- 11.9%). Clarke Error Grid analysis categorized 98.7% of the M-S pairs within "clinically acceptable" zones A and B. The CGMS is promising for potential use in critically ill patients. If validated in larger studies, the device could serve as a useful research tool for investigating the role of hyperglycemia (and strict glycemic control) in ICU patients. If further developed as a "real-time" glucose sensor, CGMS technology could ultimately prove clinically useful in the ICU, by decreasing nursing workload and/or by providing alarm signals for impending glycemic excursions.