Javid Patrick J, Halwick David R, Betit Peter, Thompson John E, Long Kenny, Zhang Yanan, Jaksic Tom, Agus Michael S D
Department of Surgery, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts, USA.
Diabetes Technol Ther. 2005 Jun;7(3):431-9. doi: 10.1089/dia.2005.7.431.
Evidence suggests that glycemic control provides clinical benefit to critically ill patients. The Extracorporeal Glucose Monitoring System (EGMS), Medtronic Minimed, Northridge, CA) has been developed to measure real-time, continuous blood glucose concentrations in patients on extracorporeal bypass. This pilot study reports the first in vitro and in vivo evaluations of EGMS in an extracorporeal circuit.
In an in vitro study, three EGMS sensors were inserted in a neonatal extracorporeal circuit. Circuit blood glucose levels were altered by saline dilution and dextrose infusion. EGMS sensors were then inserted into the venous return limb of the extracorporeal circuit in a cohort of six critically ill infants on extracorporeal life support (ECLS). Continuous glucose measurements were compared with laboratory and bedside glucose values at predefined intervals. Linear regression analyses and the Clarke error grid were constructed to analyze device accuracy.
All three in vitro EGMS sensors recorded real-time data without interruption for 48 h. EGMS glucose measurements closely correlated with reference levels (R (2) = 0.93). EGMS glucose values demonstrated an approximate 7-10 min lag while glucose concentrations were rapidly changing. Eight EGMS devices were inserted into six neonates on ECLS on day of life 6 +/- 3. EGMS correlated well with laboratory glucose (R2 = 0.61) and bedside glucose during a hyperinsulinemic euglycemic clamp (R2 = 0.78). On the Clarke error grid, 98% of readings were within zones A and B using laboratory glucose as reference, and 100% were within zones A and B using bedside glucose measurements. Blood glucose range during the in vitro study was 19-295 mg/dL and during the in vivo study was 80-257 mg/dL.
This pilot study suggests that EGMS is a reliable tool for measuring continuous blood glucose in critically ill patients connected to an extracorporeal circuit, although important limitations exist. Potential applications of this technology include intensive glucose monitoring in patients on ECLS, cardiopulmonary bypass, and renal replacement therapy.
有证据表明，血糖控制对重症患者具有临床益处。体外葡萄糖监测系统（EGMS，美敦力公司，加利福尼亚州诺斯里奇）已被开发用于测量体外循环患者的实时、连续血糖浓度。这项初步研究报告了EGMS在体外循环中的首次体外和体内评估。
在一项体外研究中，将三个EGMS传感器插入新生儿体外循环中。通过盐水稀释和葡萄糖输注改变循环血糖水平。然后将EGMS传感器插入六名接受体外生命支持（ECLS）的重症婴儿队列的体外循环静脉回流支中。在预定时间间隔将连续血糖测量值与实验室和床边血糖值进行比较。构建线性回归分析和克拉克误差网格以分析设备准确性。
所有三个体外EGMS传感器均连续48小时不间断记录实时数据。EGMS血糖测量值与参考水平密切相关（R² = 0.93）。当血糖浓度快速变化时，EGMS血糖值显示出约7 - 10分钟的滞后。在出生后第6±3天，将八个EGMS设备插入六名接受ECLS的新生儿体内。在高胰岛素正常血糖钳夹期间，EGMS与实验室血糖（R² = 0.61）和床边血糖相关性良好（R² = 0.78）。在克拉克误差网格上，以实验室血糖为参考时，98%的读数在A区和B区，以床边血糖测量值为参考时，100%的读数在A区和B区。体外研究期间血糖范围为19 - 295 mg/dL，体内研究期间为80 - 257 mg/dL。
这项初步研究表明，尽管存在重要局限性，但EGMS是测量连接体外循环的重症患者连续血糖的可靠工具。该技术的潜在应用包括对接受ECLS、体外循环和肾脏替代治疗的患者进行强化血糖监测。
