Steil Garry M, Alexander Jamin, Papas Alexandra, Monica Langer, Modi Biren P, Piper Hannah, Jaksic Tom, Gottlieb Rebecca, Agus Michael S D
Department of Medicine, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts 02115, USA.
J Diabetes Sci Technol. 2011 Jan 1;5(1):93-8. doi: 10.1177/193229681100500113.
Standard care for infants on extracorporeal life support (ECLS) relies on intermittent measurement of blood glucose (BG); however, this can lead to significant changes in BG that go unrecognized for several hours. The present study was designed to assess performance and clinical applicability of a subcutaneous glucose sensor technology modified for use as a blood-contacting sensor within the ECLS circuit.
Twelve children, aged 3 years or less, requiring ECLS support were studied. Three continuous glucose sensors (Medtronic MiniMed) were inserted into hubs placed in line with the ECLS circuit. Blood glucose was assessed with a laboratory analyzer (BG(LAB); Bayer Rapidlab 860) approximately every 5 h (mean 4.9 ± 3.3 h) with more frequent samples obtained with a bedside monitor (HemoCue) as needed. Sensor current (I(SIG)) was transmitted to a laptop computer and retrospectively calibrated using BGLAB. Sensor performance was assessed by mean absolute relative difference (MARD), linear regression slope and intercept, and correlation, all with BGLAB as reference.
The BGLAB averaged 107.6 ± 36.4 mg/dl (mean ± standard deviation) ranging from 58 to 366 mg/dl. The MARD was 11.4%, with linear regression slope (0.86 ± 0.030) and intercept (9.0 ± 3.2 mg/dl) different from 1 and 0, respectively (p < .05), and correlation (r² = 0.76; p < .001). The system was not associated with any adverse events, and placement and removal into the hubs was easily accomplished. Instances in which more frequent BG values were obtained using a bedside HemoCue (BGHEMO) monitor showed the sensor to respond rapidly to changes.
We conclude that continuous sensors can be adapted for use in an ECLS circuit with accuracy similar to or better than that achieved with the subcutaneous site. Continuous glucose monitoring in this population can rapidly detect changes in BG that would not otherwise be observed. Further studies will be needed to assess the benefit of continuous glucose monitoring in this population.
体外生命支持（ECLS）下婴儿的标准护理依赖于间歇性测量血糖（BG）；然而，这可能导致血糖出现显著变化，且数小时内未被察觉。本研究旨在评估一种经改良可在ECLS回路中用作血液接触传感器的皮下葡萄糖传感器技术的性能和临床适用性。
对12名3岁及以下需要ECLS支持的儿童进行研究。将三个连续葡萄糖传感器（美敦力MiniMed）插入与ECLS回路串联的接口中。使用实验室分析仪（BG(LAB)；拜耳Rapidlab 860）大约每5小时（平均4.9±3.3小时）评估一次血糖，必要时使用床边监测仪（HemoCue）获取更频繁的样本。传感器电流（I(SIG)）传输到笔记本电脑，并使用BGLAB进行回顾性校准。以BGLAB为参考，通过平均绝对相对差异（MARD）、线性回归斜率和截距以及相关性来评估传感器性能。
BGLAB的平均值为107.6±36.4mg/dl（平均值±标准差），范围为58至366mg/dl。MARD为11.4%，线性回归斜率（0.86±0.030）和截距（9.0±3.2mg/dl）分别不同于1和0（p<.05），相关性（r² = 0.76；p<.001）。该系统未发生任何不良事件，并且轻松完成了在接口中的放置和取出。使用床边HemoCue（BGHEMO）监测仪获取更频繁血糖值的情况显示，传感器对变化反应迅速。
我们得出结论，连续传感器可适用于ECLS回路，其准确性与皮下部位相似或更佳。对该人群进行连续血糖监测可快速检测到否则将无法观察到的血糖变化。需要进一步研究来评估该人群连续血糖监测的益处。
