Intensive Care Unit, Hospital Universitario San Cecilio, Granada, Spain.
Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.
Nurs Crit Care. 2022 Sep;27(5):711-717. doi: 10.1111/nicc.12622. Epub 2021 Apr 13.
The measurement of blood glucose in critically ill patients is still performed in many ICUs with glucose meters and capillary samples. Several prevalent factors in these patients affect the accuracy of the results and should be interpreted with caution. A weak recommendation from the Surviving Sepsis Campaign (SSC) suggests the use of arterial blood rather than capillary blood for point of care testing using glucose meters.
To analyse the agreement between arterial, central venous, and capillary blood samples of glucose values measured by glucose meter in critically ill patients and study potential confounding factors.
Prospective cross-sectional study in a general intensive care unit (ICU). Patients needing insulin treatment (subcutaneous or intravenous) and blood glucose control were included.
Standardized collection of blood samples and measurement of glucose values with a glucometer. Agreement was studied by the Bland-Altman method and stratified analysis of disagreement-survival plots was used to study the influence of haematocrit, pH range, SOFA score, capillary refilling time, intravenous insulin infusion, and lactic acid.
A total of 297 measurements from 54 patients were included. The mean arterial blood glucose was 150.42 (range 31-345 mg/dL). In the graphical analysis, there is a poor agreement both in capillary and venous central to arterial samples, but in opposite direction (underestimation of capillary and overestimation of central venous). Factors associated with a reduction in the agreement between arterial and capillary samples were elevated lactate, poor capillary refilling, and hemodynamic failure. Patients without hemodynamic compromise have an acceptable agreement with values for absolute differences of 16 mg/dL for a disagreement of 10%.
In critically ill patients, the measurement of blood glucose with a glucose meter should be performed with arterial samples whenever possible. Capillary samples do not accurately estimate arterial blood glucose values in patients with shock and/or vasoactive drugs and underestimate the values in the range of hypoglycemia. Venous samples are subject to error because of potential contamination.
This study adds support to the recommendation of using arterial blood rather than capillary or venous blood when using glucose meters in critically ill patients, especially in those with hemodynamic failure.
在许多 ICU 中，仍使用血糖仪和毛细血管样本来测量危重症患者的血糖。这些患者中存在一些普遍存在的因素会影响结果的准确性，因此应谨慎解读。拯救脓毒症运动（SSC）的一项弱推荐建议使用动脉血而不是毛细血管血进行床边即时检测血糖仪。
分析使用血糖仪测量危重症患者动脉血、中心静脉血和毛细血管血葡萄糖值之间的一致性，并研究潜在的混杂因素。
在普通重症监护病房（ICU）进行前瞻性横断面研究。纳入需要胰岛素治疗（皮下或静脉）和血糖控制的患者。
标准化采集血液样本，使用血糖仪测量血糖值。采用 Bland-Altman 法研究一致性，并对差异-生存图进行分层分析，以研究血细胞比容、pH 值范围、SOFA 评分、毛细血管再充盈时间、静脉胰岛素输注和乳酸的影响。
共纳入 54 例患者的 297 次测量值。平均动脉血糖为 150.42（范围 31-345mg/dL）。在图形分析中，毛细血管和中心静脉与动脉样本之间的一致性均较差，但方向相反（毛细血管低估，中心静脉高估）。与动脉和毛细血管样本之间一致性降低相关的因素是乳酸升高、毛细血管再充盈不良和血流动力学衰竭。无血流动力学障碍的患者，对于差异为 16mg/dL 的不一致性，其绝对值差异的可接受性为 10%。
在危重症患者中，只要可能，应使用动脉样本进行血糖仪测量血糖。在休克和/或血管活性药物患者中，毛细血管样本不能准确估计动脉血糖值，且在低血糖范围内会低估值。静脉样本由于潜在污染而存在误差。
本研究为使用血糖仪时建议使用动脉血而不是毛细血管或静脉血提供了支持，特别是在血流动力学衰竭的患者中。
