Pilot study: Continuous intravenous glucose monitoring versus intermittent monitoring in critically ill patients after complex cardiac - and neurosurgery.

Brackel, E.A. (2014) Pilot study: Continuous intravenous glucose monitoring versus intermittent monitoring in critically ill patients after complex cardiac - and neurosurgery. thesis, Medicine.

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Abstract

Introduction: Both critical illness and the postoperative phase are known to induce hyperglycemia (blood glucose > 8.0 mmol/L). This hyperglycemia can result in a deleterious impact on patient outcome and increase mortality along critically ill patients. To implement an effective tight glycemic control and improve the patient outcome, real-time continuous glucose monitors (CGMs) are considered. This pilot study evaluated two of these CGMs, the Glucoclear® (Edward Lifesciences, USA) and the Eirus® (Maquet, Sweden), for their accuracy in measuring blood glucose levels and detecting changes. Also their usability was evaluated. Furthermore possible causes of hypo- and hyperglycemic events (e.g. cardioplegia, dexamethasone) were observed. Material and Methods: Thirteen patients were included, who underwent major cardiothoracic - and neurosurgery. The CGMs were placed preoperatively and afterwards the patients were admitted at the ICU where further measurement took place. The glucose measurements of the CGMS were compared with the simultaneous measured glucose values of the generally considered gold standard, the Radiometer ABL 700®. For analysis, the data was collected, from all included patients per group, as paired measurements. For evaluating the accuracy, a Clarke Error Grid Analysis (CEGA) and Bland-Altman (BA) plot was used. In the CEGA clinically accuracy is shown when the data is found in the desirable A-B zone. In the BA plot the difference between the glucose values (y-axis) and the mean of values (x-axis) is plotted. When these differences are small, and the values are distributed between the 95% limits of agreement (mean±1.96 SD) and around the null line, agreement is shown. Also the accuracy in detecting changes was evaluated, using the relative newly developed fourquadrant plot and polar plot. Data in the four-quadrant plot is shown as

Item Type:	Thesis (Thesis)
Supervisor name:	Scheeren, Prof. Dr. T.W.L. MD and Nijsten, Dr. M.W.N. MD
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:53
Last Modified:	25 Jun 2020 10:53
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/1420

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