Piper Hannah G, Alexander Jamin L, Shukla Avinash, Pigula Frank, Costello John M, Laussen Peter C, Jaksic Tom, Agus Michael S D
Department of Surgery, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts 02115, USA.
Pediatrics. 2006 Sep;118(3):1176-84. doi: 10.1542/peds.2006-0347.
Given the demonstrated benefit of euglycemia in critically ill patients as well as the risk for hypoglycemia during insulin infusion in children, we sought to validate a subcutaneous sensor for real-time continuous glucose monitoring in pediatric patients during and after cardiac surgery.
Children up to 36 months of age who were undergoing cardiac bypass surgery were recruited. After anesthetic induction, a continuous glucose-monitoring system sensor (CGMS, Medtronic Minimed, Northridge, CA) was inserted subcutaneously. Sensors remained in place for up to 72 hours. Arterial blood glucose was measured intermittently in the central laboratory (Bayer Rapidlab 860, Tarrytown, NY). Sensor data, after prospective calibration with 6-hourly laboratory values using the proprietary Medtronic Minimed Guardian RT algorithm, were compared with all laboratory glucose values. Statistical analysis was performed to test whether sensor performance was affected by body temperature, inotrope dose, or body-wall edema.
Twenty patients were enrolled in the study for a total of 40 study days and 246 paired sensor and laboratory glucose values. Consensus error grid analysis demonstrated that 72.0% of sensor value comparisons were within zone A (no effect on clinical action), and 27.6% of comparisons were within zone B (altered clinical action of little or no effect on outcome), with a mean absolute relative deviation of 17.6% for all comparisons. One comparison (0.4%) was in zone C (altered clinical action likely to affect outcome). No significant correlations were found between sensor performance and body temperature, inotrope dose, or body-wall edema. All patients tolerated the sensors well without bleeding or tissue reaction.
Guardian RT real-time subcutaneous blood glucose measurement is safe and potentially useful for continuous glucose monitoring in critically ill children. Subcutaneous sensors performed well in the setting of hypothermia, inotrope use, and edema. These sensors facilitate identifying and following the effects of interventions to control blood glucose.
鉴于已证明严格血糖控制对危重症患者有益，以及儿童在输注胰岛素期间存在低血糖风险，我们试图验证一种皮下传感器用于小儿心脏手术期间及术后实时连续血糖监测的效果。
招募年龄达36个月且正在接受心脏搭桥手术的儿童。麻醉诱导后，皮下插入一个连续血糖监测系统传感器（CGMS，美敦力MiniMed公司，加利福尼亚州北岭）。传感器留置长达72小时。在中心实验室（纽约塔里敦的拜耳Rapidlab 860）间歇测量动脉血糖。使用美敦力MiniMed公司专有的Guardian RT算法，将传感器数据与每6小时的实验室值进行前瞻性校准后，与所有实验室血糖值进行比较。进行统计分析以测试传感器性能是否受体温、血管活性药物剂量或体壁水肿的影响。
20名患者纳入本研究，共40个研究日，有246对传感器与实验室血糖值。一致性误差网格分析表明，72.0%的传感器值比较在A区（对临床行动无影响），27.6%的比较在B区（改变临床行动但对结果影响很小或无影响），所有比较的平均绝对相对偏差为17.6%。1次比较（0.4%）在C区（改变临床行动可能影响结果）。未发现传感器性能与体温、血管活性药物剂量或体壁水肿之间存在显著相关性。所有患者对传感器耐受良好，无出血或组织反应。
Guardian RT实时皮下血糖测量对于危重症儿童的连续血糖监测是安全且可能有用的。皮下传感器在低温、使用血管活性药物和水肿情况下表现良好。这些传感器有助于识别和跟踪控制血糖干预措施的效果。
