scholarly journals SAT-639 Is the Freestyle Libre Flash Glucose Monitor Accurate in the Critically Ill?

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Brianna Johnson-Rabbett ◽  
Hiba Hashmi ◽  
Ryan Lyerla ◽  
Laura Lafave
Keyword(s):  
Critical Care ◽  
Cardiac Surgery ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Care Setting ◽  
Glucose Monitoring ◽  
Flash Glucose Monitoring ◽  
Freestyle Libre ◽  
Clinical Accuracy ◽  
Error Grid

Abstract The FreeStyle Libre flash glucose monitor (FGM) has made the use of continuous glucose monitors more accessible to the typical diabetes patient in an outpatient setting given the significantly lower cost and ease of use of FGM as compared to other systems. However, FGM is not labeled for use in a critically ill population. The critical care department at our institution queried the endocrine department about studying the use of FGM in critically ill patients. The interest of the critical care department was due to the potential of decrease in patient discomfort and decrease in time and effort of nursing and support staff related to the performance of fingerstick capillary glucoses if FGM was an adequate replacement measure. As of yet, there has been only minimal study of flash glucose monitoring in critically ill patients. One Australian study evaluated 8 patients in an ICU setting and determined that as compared with arterial blood glucose monitoring, flash glucose monitoring provided acceptable numerical and clinical accuracy.1 A Swedish study evaluated a total of 26 patients undergoing cardiac surgery and compared the use of FGM to use of a microdialysis intravascular system and concluded that the microdialysis system was more accurate, though in this study, only 25% of patients had diabetes. 2 To further investigate use of FGM in a critically ill population, we plan to undertake a single center, prospective, single arm study enrolling at least 20 and up to 40 patients. Inclusion criteria include a known diagnosis of type 1 or type 2 diabetes, age of 18 or older, and admission to the medical intensive care unit (MICU) with expected MICU stay of at least 48 hours. Participating subjects will have a sensor applied by a study investigator. After confirmation that the sensor is operational, the investigator will place opaque tape over the monitor to blind the monitor data. Nurses or medical assistants will conduct the standard of care fingerstick glucose monitoring per hospital protocol but will also have been notified of request to also pass FGM reader over the sensor at time of fingerstick glucose data collection. The primary objectives are to determine numerical accuracy in a critical care setting using the mean absolute relative difference and to determine clinical accuracy in a critical care setting using the surveillance error grid and the clarke error grid analyses. Preliminary data should be available by March, 2020. 1. Ancona P, Eastwood GM, Lucchetta L, Ekinci EI, Bellomo R, Martensson J. The performance of flash glucose monitoring in critically ill patients with diabetes. Crit Care Resusc 2017; 19: 167-174, June 2017. 2. Schierenbeck F, Franco-Cereceda A, Liska J. Accuracy of 2 Different Continuous Glucose Monitoring Systems in Patients Undergoing Cardiac Surgery: Intravascular Microdialysis Versus Subcutaneous Tissue Monitoring. Journal of Diabetes Science and Technology 2017, Vol. 11(1) 108–116

Accuracy and Stability of a Subcutaneous Flash Glucose Monitoring System in Critically Ill Patients

2021 ◽  
pp. 193229682110172
Author(s):  
Hiromu Naraba ◽  
Tadahiro Goto ◽  
Mitsuhiro Tokuda ◽  
Tomohiro Sonoo ◽  
Hidehiko Nakano ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Glucose Monitoring ◽  
Blood Gas Analysis ◽  
Relative Difference ◽  
Gas Analysis ◽  
Blood Gas ◽  
Flash Glucose Monitoring ◽  
Grid Analysis ◽  
Error Grid

Background: Flash glucose monitoring (FGM) systems can reduce glycemic variability and facilitate blood glucose management within the target range. However, in critically ill patients, only small ( n < 30) studies have examined the accuracy of FGM and none have assessed the stability of FGM accuracy. We evaluated the accuracy and stability of FGM in critically ill patients. Method: This was a single-center, retrospective observational study. We included a total of 116 critically ill patients who underwent FGM for glycemic control. The accuracy of FGM was assessed as follows using blood gas glucose values as a reference: (1) numerical accuracy using the mean absolute relative difference, (2) clinical accuracy using consensus error grid analysis, and (3) stability of accuracy assessing 14-day trends in consensus error grid distribution. Results: FGM sensors remained in situ for a median of 6 [4, 11] days. We compared 2014 pairs of measurements between the sensor and blood gas analysis. Glucose values from the sensor were consistently lower, with a mean absolute relative difference of 13.8% (±16.0%), than those from blood gas analysis. Consensus error grid analysis demonstrated 99.4% of the readings to be in a clinically acceptable accuracy zone. The accuracy of FGM was stable across the 14 days after device insertion. Conclusions: FGM had acceptable reliability and accuracy to arterial blood gas analysis in critically ill patients. In addition, the accuracy of FGM persisted for at least 14 days. Our study promotes the potential usefulness of FGM for glycemic monitoring in critically ill patients.

Anticonvulsants: Pharmacotberapeutic Issues in the Critically Ill Patient

1991 ◽  
Vol 2 (4) ◽  
pp. 639-656 ◽  
Author(s):  
Robert E. Dupuis ◽  
Jorge Miranda-Massari
Keyword(s):  
Critical Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Care Setting ◽  
Critical Care Setting ◽  
Critically Ill Patient ◽  
Care Nurse ◽  
Critical Care Nurse ◽  
Epilepsy Treatment

Critically ill patients often have or develop conditions that make them susceptible to seizures and epilepsy. Treatment frequently involves the use of anticonvulsants. In order to use these effectively, the critical care nurse must be aware of the indications and controversies surrounding their use, the pathophysiologic conditions that impact on the disposition, and appropriate dosing and monitoring of these agents in the critical care setting

scholarly journals COVID 19 CRITICAL CARE TRAINING SURGE EXPERIENCE FOR PHYSICIANS IN RIYADH HEALTH CLUSTER ONE, SAUDI ARABIA

2020 ◽  
Vol 2020 (1) ◽  
Author(s):  
AF Mady ◽  
O Ramdan ◽  
R Al Yousef ◽  
A Ishag ◽  
G Bakirova ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Critical Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Care Setting ◽  
Basic Knowledge ◽  
The World ◽  
Medical City ◽  
Care Training ◽  
Icu Physicians

As the COVID-19 pandemic spreads, the number of critically ill patients is expected to surge in hospitals across the world. This may result in non-ICU clinicians being needed to care for critically ill patients, In line with Pandemic COVID – 19 situations that we are facing currently; the Critical Care Department Training Committee of King Saud Medical City in collaboration with the Riyadh Health Cluster One, Saudi Arabia conducted a series of training projects. Its goal is to help non – ICU Physicians to be equipped and be more competent to handle critically ill patients when the situation will have the need for it. We aim to provide basic knowledge and skills to successfully manage critically ill patients with suspected or confirmed COVID – 19 cases in a critical care setting.

scholarly journals Accuracy of Flash Glucose Monitoring During Postprandial Rest and Different Walking Conditions in Overweight or Obese Young Adults

2021 ◽  
Vol 12 ◽  
Author(s):  
Xiaoyuan Zhang ◽  
Fenghua Sun ◽  
Waris Wongpipit ◽  
Wendy Y. J. Huang ◽  
Stephen H. S. Wong
Keyword(s):  
Young Adults ◽  
Glucose Monitoring ◽  
Postprandial Glucose ◽  
Relative Difference ◽  
Flash Glucose Monitoring ◽  
Grid Analysis ◽  
Crossover Studies ◽  
Freestyle Libre ◽  
Clarke Error Grid ◽  
Error Grid

Aims: To investigate the accuracy of FreeStyle LibreTM flash glucose monitoring (FGM) relevant to plasma glucose (PG) measurements during postprandial rest and different walking conditions in overweight/obese young adults.Methods: Data of 40 overweight/obese participants from two randomized crossover studies were pooled into four trials: (1) sitting (SIT, n = 40); (2) walking continuously for 30 min initiated 20 min before individual postprandial glucose peak (PPGP) (20iP + CONT, n = 40); (3) walking continuously for 30 min initiated at PPGP (iP + CONT, n = 20); and (4) accumulated walking for 30 min initiated 20 min before PPGP (20iP + ACCU, n = 20). Paired FGM and PG were measured 4 h following breakfast.Results: The overall mean absolute relative difference (MARD) between PG and FGM readings was 16.4 ± 8.6% for SIT, 16.2 ± 4.7% for 20iP + CONT, 16.7 ± 12.2% for iP + CONT, and 19.1 ± 6.8% for 20iP + ACCU. The Bland–Altman analysis showed a bias of −1.03 mmol⋅L–1 in SIT, −0.89 mmol⋅L–1 in 20iP + CONT, −0.82 mmol⋅L–1 in iP + CONT, and −1.23 mmol⋅L–1 in 20iP + ACCU. The Clarke error grid analysis showed that 99.6–100% of the values in all trials fell within zones A and B.Conclusion: Although FGM readings underestimated PG, the FGM accuracy was overall clinically acceptable during postprandial rest and walking in overweight/obese young adults.

scholarly journals The effect of opioids on gastrointestinal function in the ICU

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Yun Yan ◽  
Yu Chen ◽  
Xijing Zhang
Keyword(s):  
Critical Care ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Potential Risk ◽  
Critically Ill Patients ◽  
Care Setting ◽  
Critical Care Setting ◽  
Gastrointestinal Function ◽  
Opioid Antagonists

AbstractGastrointestinal (GI) dysfunction is common in the critical care setting and is highly associated with clinical outcomes. Opioids increase the risk for GI dysfunction and are frequently prescribed to reduce pain in critically ill patients. However, the role of opioids in GI function remains uncertain in the ICU. This review aims to describe the effect of opioids on GI motility, their potential risk of increasing infection and the treatment of GI dysmotility with opioid antagonists in the ICU setting.

scholarly journals Clinical Evaluation of Subcutaneous Lactate Measurement in Patients after Major Cardiac Surgery

2009 ◽  
Vol 2009 ◽  
pp. 1-8
Author(s):  
Martin Ellmerer ◽  
Martin Haluzik ◽  
Jan Blaha ◽  
Jaromir Kremen ◽  
Stepan Svacina ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Glucose Monitoring ◽  
Blood Analysis ◽  
Arterial Blood ◽  
Lactate Measurement ◽  
Lactate Sensor ◽  
A Site ◽  
Invasive Techniques

Minimally invasive techniques to access subcutaneous adipose tissue for glucose monitoring are successfully applied in type1 diabetic and critically ill patients. During critical illness, the addition of a lactate sensor might enhance prognosis and early intervention. Our objective was to evaluate SAT as a site for lactate measurement in critically ill patients. In 40 patients after major cardiac surgery, arterial blood and SAT microdialysis samples were taken in hourly intervals. Lactate concentrations from SAT were prospectively calibrated to arterial blood. Analysis was based on comparison of absolute lactate concentrations (arterial blood vs. SAT) and on a 6-hour lactate trend analysis, to test whether changes of arterial lactate can be described by SAT lactate. Correlation between lactate readings from arterial blood vs. SAT was highly significant (r2=0.71,P<.001). Nevertheless, 42% of SAT lactate readings and 35% of the SAT lactate trends were not comparable to arterial blood. When a 6-hour stabilization period after catheter insertion was introduced, 5.5% of SAT readings and 41.6% of the SAT lactate trends remained incomparable to arterial blood. In conclusion, replacement of arterial blood lactate measurements by readings from SAT is associated with a substantial shortcoming in clinical predictability in patients after major cardiac surgery.

scholarly journals Updates in Nutrition Support for Critically III Adult Patients

2017 ◽  
Vol 52 (1) ◽  
pp. 17-26 ◽  
Author(s):  
Diana Wells Mulherin ◽  
Sarah V. Cogle
Keyword(s):  
Critical Care ◽  
Enteral Nutrition ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Care Setting ◽  
Hospital Pharmacist ◽  
Critical Care Medicine ◽  
Critical Care Setting ◽  
Nutrition Support ◽  
American Society

Specialized nutrition support is often employed in critically ill patients who are unable to maintain volitional intake. The Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) recently updated guidelines for the provision of nutrition support in critically ill patients. The purpose of this review is to summarize key changes from the previous guidelines as they relate to recently published literature, which will aid the hospital pharmacist in optimizing nutrition support therapies in the critical care setting.

Academic education. Creating a laboratory that simulates the critical care environment

1996 ◽  
Vol 16 (6) ◽  
pp. 76-81 ◽  
Author(s):  
PG Morton
Keyword(s):  
Critical Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Care Setting ◽  
Teaching Method ◽  
Critical Care Setting ◽  
Academic Education ◽  
Clinical Experiences ◽  
Care Environment ◽  
Excellent Teaching

Educating students and practicing nurses for the complexities and demands of critical care is a challenge. Training in a laboratory that simulates the critical care setting is an excellent teaching method that can be used to supplement lectures and clinical experiences. Developing such a laboratory is an exciting and rewarding process that will promote learning and ultimately benefit the care of critically ill patients.

Psychopharmacology in the Critical Care Setting

2021 ◽  
pp. 235-250
Author(s):  
Sandeep Nayak ◽  
Jonathan Brigham ◽  
Ted Avi Gerstenblith ◽  
Elizabeth Prince
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Critical Illness ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Care Setting ◽  
Psychotropic Medications ◽  
Oral Medication ◽  
Critical Care Setting ◽  
Confounding Factors

Psychotropic medications can be a powerful tool for enabling treatment of critically ill patients. However, a careful approach to psychopharmacology is necessary in the critical care setting. Special considerations include interactions with other medications and treatments, high levels of physiologic stress that alter metabolism, and the challenges of obtaining diagnostic clarity due to limitations in assessment and confounding factors during critical illness. This chapter outlines common consult questions posed by intensive care teams to psychiatry consultation teams, including management of agitation and sedation, poor participation in care, anxiety, continuation of outpatient medication regimens, and alternatives to oral medication.

scholarly journals Electroencephalogram Monitoring in Critical Care

2020 ◽  
Vol 40 (06) ◽  
pp. 675-680
Author(s):  
Clio Rubinos ◽  
Ayham Alkhachroum ◽  
Caroline Der-Nigoghossian ◽  
Jan Claassen
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Critical Care Unit ◽  
Care Setting ◽  
Eeg Monitoring ◽  
Electroencephalogram Eeg ◽  
Brain Monitoring

AbstractSeizures are common in critically ill patients. Electroencephalogram (EEG) is a tool that enables clinicians to provide continuous brain monitoring and to guide treatment decisions—brain telemetry. EEG monitoring has particular utility in the intensive care unit as most seizures in this setting are nonconvulsive. Despite the increased use of EEG monitoring in the critical care unit, it remains underutilized. In this review, we summarize the utility of EEG and different EEG modalities to monitor patients in the critical care setting.

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