Mishra Keshabanand, Mishra Shivanand, Katial Tanmay
Department of Anaesthesiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
Int J Crit Illn Inj Sci. 2024 Apr-Jun;14(2):74-78. doi: 10.4103/ijciis.ijciis_76_23. Epub 2024 Jun 21.
Accurately monitoring blood glucose levels is vital for critically ill individuals. Point-of-care (POC) glucose meters are commonly used in local intensive care units (ICUs). This study aimed to assess the precision of POC glucose meter readings in critically ill individuals with specific evaluation in patients with and without shock against the reference standard of venous blood glucose measurements.
An observational study was done on adult patients admitted in the ICU at a teaching institution. Capillary blood samples were collected from the patient's fingertip using lancet device with aseptic measures. The sample was analyzed using the GlucoCare Sense Glucometer (RMD Mediaids Limited, Taiwan). At the same time, 2 ml of blood was drawn from the patient's peripheral veins and analyzed by glucose oxidase-peroxidase method as reference.
POC glucose measurements averaged 140 ± 20.23 mg/dl, while laboratory values were recorded as 116.10 ± 17.13 mg/dl. The difference between the two methods was 24.34 ± 12.01 mg/dl. A strong correlation ( = 0.805) was found between capillary and laboratory blood glucose levels, indicating a significant association ( < 0.0001). Twenty-two (44%) patients were in shock during the study. The mean difference between laboratory and POC blood glucose levels was higher in patients with circulatory shock (36.82 ± 4.84 mg/dl) than those without shock (14.61 ± 4.49 mg/dl), < 0.05.
POC glucose meters may lead to underdetection of hypoglycemia in critically ill patients, as their values are higher than laboratory values. Moreover, the results showed that POC glucometers are inaccurate for monitoring glucose in hypotensive patients in shock. Standard venous glucose monitoring methods may be more appropriate for these patients.
准确监测血糖水平对重症患者至关重要。即时检测（POC）血糖仪在当地重症监护病房（ICU）中普遍使用。本研究旨在评估重症患者POC血糖仪读数的准确性，并特别评估休克和非休克患者相对于静脉血糖测量参考标准的情况。
对一家教学机构ICU收治的成年患者进行了一项观察性研究。使用采血针装置并采取无菌措施从患者指尖采集毛细血管血样。使用GlucoCare Sense血糖仪（RMD Mediaids Limited，台湾）对样本进行分析。同时，从患者外周静脉抽取2ml血液，并通过葡萄糖氧化酶 - 过氧化物酶法进行分析作为参考。
POC血糖测量平均值为140±20.23mg/dl，而实验室测量值记录为116.10±17.13mg/dl。两种方法之间的差异为24.34±12.01mg/dl。发现毛细血管血糖水平与实验室血糖水平之间存在强相关性（= 0.805），表明存在显著关联（<0.0001）。在研究期间，22名（44%）患者处于休克状态。循环休克患者的实验室血糖水平与POC血糖水平之间的平均差异（36.82±4.84mg/dl）高于非休克患者（14.61±4.49mg/dl），<0.05。
POC血糖仪可能导致重症患者低血糖检测不足，因为其测量值高于实验室测量值。此外，结果表明POC血糖仪在监测休克低血压患者的血糖时不准确。标准静脉血糖监测方法可能更适合这些患者。
