Use of Continuous Glucose Monitor in Critically Ill COVID-19 Patients Requiring Insulin Infusion: An Observational Study
Use of Continuous Glucose Monitor in Critically Ill COVID-19 Patients Requiring Insulin Infusion: An Observational Study
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DOI：
10.1210/clinem/dgab409
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发表时间：
2021-10-01
影响因子：
5.8
通讯作者：
Dungan, Kathleen
中科院分区：
文献类型：
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作者：
Faulds, Eileen R.;Boutsicaris, Andrew;Dungan, Kathleen
内容：2019冠状病毒病2019冠状病毒病（COVID-19）大流行导致重症监护室（ICU）需要远程血糖（BG）监测。目的：评估ICU中床旁（POC）BG+动态血糖监测仪（CGM）混合监测策略的可行性和患者安全性。设计：回顾性分析。设置：学术医疗中心的ICU。患者：接受IV胰岛素治疗的COVID-19患者。干预：在满足初始验证标准后，使用CGM进行IV胰岛素滴定，每6小时或根据需要进行一次POC BG。主要结局指标：结局包括POC BG的频率、工作流程、安全性和准确性指标。结果：该研究包括19名患者，其中18名有CGM数据，平均年龄58岁，89%接受机械通气，37%接受血管加压药，42%接受透析。CGM确认的中位时间为137分钟（四分位距[IQR] 114-206）。静脉注射胰岛素期间，第1天的POC值中位数为7（IQR 6-16），此后略有下降（与标准的24/天相比下降了71%）。第1天非连续性用于滴定IV胰岛素的CGM值的中位数为11.5（IQR 0，15），此后增加。在70至180 mg/dL范围内的时间在第1天为64 23%，在第2天至第7天为72 +/- 16%，而在第2天至第7天为72 +/- 16%，
Context: The coronavirus disease 2019 (COVID-19) pandemic has created a need for remote blood glucose (BG) monitoring in the intensive care unit (ICU).Objective: To evaluate feasibility and patient safety of a hybrid monitoring strategy of point-of-care (POC) BG plus continuous glucose monitor (CGM) in the ICU.Design: Retrospective analysis.Setting: ICU of an academic medical center.Patients: Patients with COVID-19 on IV insulin.Intervention: After meeting initial validation criteria, CGM was used for IV insulin titration and POC BG was performed every 6 hours or as needed.Main Outcome Measures: Outcomes included frequency of POC BG, workflow, safety, and accuracy measures.Results: The study included 19 patients, 18 with CGM data, mean age 58 years, 89% on mechanical ventilation, 37% on vasopressors, and 42% on dialysis. The median time to CGM validation was 137 minutes (interquartile range [IQR] 114-206). During IV insulin, the median number of POC values was 7 (IQR 6-16) on day 1, and declined slightly thereafter (71% reduction compared with standard of 24/day). The median number of CGM values used nonadjunctively to titrate IV insulin was 11.5 (IQR 0, 15) on day 1 and increased thereafter. Time in range 70 to 180 mg/dL was 64 23% on day 1 and 72 +/- 16% on days 2 through 7, whereas time