scholarly journals Role of continuous subcutaneous glucose monitoring in intensive care

2013 ◽  
Vol 154 (27) ◽  
pp. 1043-1048 ◽  
Author(s):  
Gábor Marics ◽  
Levente Koncz ◽  
Anna Körner ◽  
Borbála Mikos ◽  
Péter Tóth-Heyn
Keyword(s):  
Intensive Care ◽  
Glycaemic Control ◽  
Intensive Care Units ◽  
Continuous Glucose Monitoring ◽  
Pediatric Population ◽  
Glucose Monitoring ◽  
Tissue Perfusion ◽  
Close Monitoring ◽  
Beneficial Effects ◽  
Increased Risk

Critical care associated with stress hyperglycaemia has gained a new view in the last decade since the demonstration of the beneficial effects of strong glycaemic control on the mortality in intensive care units. Strong glycaemic control may, however, induce hypoglycaemia, resulting in increased mortality, too. Pediatric population has an increased risk of hypoglycaemia because of the developing central nervous system. In this view there is a strong need for close monitoring of glucose levels in intensive care units. The subcutaneous continuous glucose monitoring developed for diabetes care is an alternative for this purpose instead of regular blood glucose measurements. It is important to know the limitations of subcutaneous continuous glucose monitoring in intensive care. Decreased tissue perfusion may disturb the results of subcutaneous continuous glucose monitoring, because the measurement occurs in interstitial fluid. The routine use of subcutaneous continuous glucose monitoring in intensive care units is not recommended yet until sufficient data on the reliability of the system are available. The Medtronic subcutaneous continuous glucose monitoring system is evaluated in the review partly based on the authors own results. Orv. Hetil., 2013, 154, 1043–1048.

scholarly journals Implementation of a Continuous Glucose Monitoring Program at a Safety Net Hospital During Covid 19 Pandemic

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A345-A346
Author(s):  
Erin E Finn ◽  
Lindsay Schlichting ◽  
Rocio Ines Pereira
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Continuous Glucose Monitoring ◽  
Monitoring Program ◽  
Glucose Monitoring ◽  
Safety Net ◽  
Surgical Intensive Care Unit ◽  
Close Monitoring ◽  
Safety Net Hospital ◽  
Urban Safety

Abstract Background: COVID 19 disproportionately impacts individuals with diabetes leading to increased morbidity and mortality. Hyperglycemia is common in hospitalized patients with COVID requiring intensive monitoring and management. Close monitoring of glucoses requires increased use of personal protective equipment (PPE), which has been in limited supply since the beginning of the pandemic. The FDA granted conditional allowance for use of continuous glucose monitors (CGM) in hospital settings during the COVID pandemic to allow for preservation of PPE. We present the process of implementing a continuous glucose monitoring program in an urban safety net hospital. Methods: The program was implemented at a county urban safety net hospital. Patients were eligible to be started on Dexcom G6 CGM if they had hyperglycemia requiring multiple insulin injections daily, were in contact isolation, and were located in 1 of 3 units of the hospital (medical intensive care unit [MICU], surgical intensive care unit, COVID 19 floor unit). Initial program was started in the MICU and subsequently expanded. Nurses and staff underwent training using videos, in-person demonstrations, and written guides. Informational Technology modified the electronic medical system to allow for ordering and documentation of CGM values by nurses. Supplies were stored both on unit and in central supply allowing for primary team to initiate monitoring independent of diabetes team. Records of patients participating in program were maintained by the diabetes team. Amount of PPE saved was estimated to be 10 instances/day while on insulin drip and 3/day when using subcutaneous insulin. Results: A total of 69 patients used a CGM during their hospital course. Average age was 56 years old, 69 % were male, average BMI 31, and 84% had known diabetes prior to admission. The majority of patients were critically ill with 68% intubated, 48% on vasopressors, 6% requiring dialysis, 38% on insulin drip, 46% were on tube feeds, and 74% received steroids. The racial demographics of the patients were 72% White, 3% Black, 4% Native American, 4% Asian, and 14% other. For ethnicity, 73% identified as Hispanic and half spoke Spanish as their primary language. An estimated 2600 instances of PPE were saved. Challenges that were faced in implementing the program included consistent training of large numbers of staff, maintaining supplies in stock, troubleshooting discordant values, and restricting use of CGM to patients who met qualifications. Conclusion: Overall, the implementation of CGM was successful and received a positive response. Staff in the primary units quickly became comfortable with the application of the technology. Potential challenges in the future include ongoing training, improving troubleshooting of technology, validating the accuracy of the devices, and developing funding for CGM equipment and interpretation.

EXPRESS: Monitoring Motherhood: monitoring and optimising glycaemia in women with pre-existing diabetes in pregnancy

2021 ◽  
pp. 000456322110358
Author(s):  
Claire L Meek
Keyword(s):  
Glycaemic Control ◽  
Continuous Glucose Monitoring ◽  
Multiple Pregnancy ◽  
Glucose Monitoring ◽  
Insulin Dosage ◽  
Diabetes In Pregnancy ◽  
Short Term ◽  
Increased Risk ◽  
Mother And Child ◽  
In Pregnancy

Despite recent advances in care, women with diabetes in pregnancy are still at increased risk of multiple pregnancy complications. Offspring exposed to hyperglycaemia in utero also experience long-term health sequelae affecting neurocognitive and cardiometabolic status. Many of these adverse consequences can be prevented or ameliorated with good medical care, specifically to optimise glycaemic control. The accurate assessment of glycaemia in pregnancy is therefore vital to safeguard the health of mother and child. However, there is no consensus about the best method of monitoring glycaemic control in pregnancy. Short-term changes in insulin dosage and lifestyle, with altered appetite, insulin sensitivity and red cell turnover create difficulties in interpretation of standard laboratory measures such as HbA1c. The ideal marker would provide short-term feedback on daily or weekly glycaemic control, with additional capability to predict pregnancies at high risk of suboptimal outcomes. Several novel biochemical markers are available which allow assessment of dynamic changes in glycaemia over weeks rather than months. Continuous glucose monitoring devices have advanced in accuracy and provide new opportunities for robust assessment of glycaemia in pregnancy. Recent work from the continuous glucose monitoring in pregnant women with type 1 diabetes trial (CONCEPTT) has provided information about the ability of different markers of glycaemia to predict pregnancy outcomes. The aim of this review is to summarise the care for women with pre-existing diabetes in pregnancy, and to highlight the important role of glycaemic monitoring in pregnancy.

Use of Continuous Glucose Monitoring Can Address Patient Fears and Facilitate Improved Glycaemic Management

2010 ◽  
Vol 7 (2) ◽  
pp. 88
Author(s):  
Jeff Unger ◽  
Chris Parkin ◽  
◽  
Keyword(s):  
Glycaemic Control ◽  
Continuous Glucose Monitoring ◽  
Diabetes Management ◽  
Severe Hypoglycaemia ◽  
Glucose Monitoring ◽  
Monitoring Strategies ◽  
Increased Risk ◽  
Patients At Risk ◽  
Intensively Managed ◽  
Chronic Hyperglycaemia

Effective diabetes management can delay or prevent many of the complications of diabetes. Achieving optimal glycaemic control, however, often requires intensive insulin treatment, which is associated with an increased risk of severe hypoglycaemia. Many intensively managed patients are reluctant to follow and/or adjust their insulin regimens as needed because of fear of hypoglycaemia. This lack of adherence can result in exposure to chronic hyperglycaemia, oxidative stress and long-term complications. Severe hypoglycaemia can be prevented through vigilance in identifying patients at risk, using appropriate medications and medication regimens, and effective glucose monitoring strategies and technologies. This article reviews some evidence relevant to hypoglycaemia in intensively managed patients and discusses how tools such as continuous glucose monitoring (CGM) can help patients overcome their fear of hypoglycaemia and safely achieve optimal glycaemic control.

PREVALENCE OF CARBAPENEM-RESISTANT ACINETOBACTER BAUMANNII (CRAB) IN MEDICAL AND SURGICAL INTENSIVE CARE UNITS (ICUS) OF JPMC, KARACHI

2019 ◽  
Author(s):  
Rabia Arshad
Keyword(s):  
Intensive Care ◽  
Antimicrobial Resistance ◽  
Acinetobacter Baumannii ◽  
Intensive Care Units ◽  
Carbapenem Resistance ◽  
Chronic Obstructive ◽  
Surgical Intensive Care ◽  
Carbapenem Resistant ◽  
Number Of Patients ◽  
Increased Risk

Background: Antimicrobial resistance is one of the research priorities of health organizations due to increased risk of morbidity and mortality. Outbreaks of nosocomial infections caused by carbapenem-resistant Acinetobacter Baumannii (CRAB) strains are at rise worldwide. Antimicrobial resistance to carbapenems reduces clinical therapeutic choices and frequently led to treatment failure. The aim of our study was to determine the prevalence of carbapenem resistance in A. baumannii isolated from patients in intensive care units (ICUs). Methods: This cross-sectional study was carried out in the Department of Microbiology, Basic Medical Sciences Institute (BMSI), Jinnah Postgraduate Medical Centre (JPMC), Karachi, from December 2016 to November 2017. Total 63 non-repetitive A. baumannii were collected from the patients’ specimens, admitted to medical and surgical ICUs and wards of JPMC, Karachi. The bacterial isolates were processed according to standard microbiological procedures to observe for carbapenem resistance. SPSS 21 was used for data analysis. Results: Out of the 63 patients, 40 (63.5%) were male. The age of the patient ranged from 15-85 year, with average of 43 year. 34.9% patients had been hospitalized for 3 days. Chronic obstructive pulmonary disease was present in highest number with average of 58.7% for morbidity. Number of patients on mechanical ventilation was highest (65.1%). All isolates were susceptible to colistin. The resistance to ampicillin-sulbactam, ceftazidime, ciprofloxacin, amikacin, piperacillin- tazobactam and meropenem was 82.5%, 81%, 100%, 87.3%, 82.5% and 82% respectively. Out of 82% CRAB, 77% were obtained from ICUs. Conclusion: This study has revealed the high rate of carbapenem resistance in A. baumannii isolates in ICUs thus leaving behind limited therapeutic options.

The Accuracy of Continuous Glucose Monitoring in the Medical Intensive Care Unit

2021 ◽  
pp. 193229682110275
Author(s):  
Wannita Tingsarat ◽  
Patinut Buranasupkajorn ◽  
Weerapan Khovidhunkit ◽  
Patchaya Boonchaya-anant ◽  
Nitchakarn Laichuthai
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Continuous Glucose Monitoring ◽  
Medical Intensive Care Unit ◽  
Glucose Monitoring ◽  
Relative Difference ◽  
Risk Zone ◽  
Medical Intensive Care ◽  
Vasopressor Use ◽  
Error Grid

Objective: To assess the accuracy of continuous glucose monitoring (CGM) in medical intensive care unit (MICU) patients. Methods: A Medtronic Enlite® sensor accuracy was assessed versus capillary blood glucose (CBG) and plasma glucose (PG) using the mean absolute relative difference (MARD), surveillance error grid (SEG) analysis and modified Bland-Altman plots. Results: Using CBG as a reference, MARD was 6.6%. Overall, 99.7% of the CGM readings were within the “no risk” zone. No significant differences in accuracy were seen within vasopressor subgroups. Using PG as the reference, MARD was 8.8%. The surveillance error grid analysis showed 95.2% of glucose readings were within the “no risk” zone. There were no device-related adverse events. Conclusion: The CGM sensor showed acceptable accuracy in MICU patients, regardless of vasopressor use.

scholarly journals The national rate of intensive care units-acquired infections, one-year retrospective study in Iran

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Neda Izadi ◽  
Babak Eshrati ◽  
Yadollah Mehrabi ◽  
Korosh Etemad ◽  
Seyed-Saeed Hashemi-Nazari
Keyword(s):  
Intensive Care ◽  
Tract Infection ◽  
Intensive Care Units ◽  
Bloodstream Infections ◽  
Surgical Site Infections ◽  
Increased Risk ◽  
Neonatal Icu ◽  
Mortality Causes ◽  
One Year ◽  
Multi Center Study

Abstract Background Hospital-acquired infections (HAIs) in intensive care units (ICUs) are among the avoidable morbidity and mortality causes. This study aimed at investigating the rate of ICU-acquired infections (ICU-AIs) in Iran. Methods For the purpose of this multi-center study, the rate of ICU-AIs calculated based on the data collected through Iranian nosocomial infections surveillance system and hospital information system. The data expanded based on 12 months of the year (13,632 records in terms of “hospital-ward-month”), and then, the last observation carried forward method was used to replace the missing data. Results The mean (standard deviation) age of 52,276 patients with HAIs in the ICUs was 47.37 (30.78) years. The overall rate of ICU-AIs was 96.61 per 1000 patients and 16.82 per 1000 patient-days in Iran’s hospitals. The three main HAIs in the general ICUs were ventilator-associated events (VAE), urinary tract infection (UTI), and pneumonia events & lower respiratory tract infection (PNEU & LRI) infections. The three main HAIs in the internal and surgical ICUs were VAE, UTI, and bloodstream infections/surgical site infections (BSI/SSI). The most prevalent HAIs were BSI, PNEU & LRI and eye, ear, nose, throat, or mouth (EENT) infections in the neonatal ICU and PNEU & LRI, VAE, and BSI in the PICU. Device, catheter, and ventilator-associated infections accounted for 60.96, 18.56, and 39.83% of ICU-AIs, respectively. The ventilator-associated infection rate was 26.29 per 1000 ventilator-days. Based on the Pabon Lasso model, the lowest rates of ICU-AIs (66.95 per 1000 patients and 15.19 patient-days) observed in zone III, the efficient area. Conclusions HAIs are common in the internal ICU wards. In fact, VAE and ventilator-related infections are more prevalent in Iran. HAIs in the ICUs leads to an increased risk of ICU-related mortality. Therefore, to reduce ICU-AIs, the specific and trained personnel must be responsible for the use of the devices (catheter use and ventilators), avoid over use of catheterization when possible, and remove catheters earlier.

scholarly journals Colonization of central venous catheter in the intensive care units at the Institute of Cardiovascular Disease "Dedinje": One year study

2005 ◽  
Vol 52 (3) ◽  
pp. 33-37
Author(s):  
Ivana Cirkovic ◽  
Vera Mijac ◽  
Milena Svabic-Vlahovic ◽  
S. Dukic ◽  
I. Ilic ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Antimicrobial Agents ◽  
Microbial Colonization ◽  
Central Venous ◽  
Candida Spp ◽  
Icu Patients ◽  
Gram Negative ◽  
Microbiological Methods ◽  
Increased Risk

Objectives: The application of Central Venous Catheters (CVC) is associated with increased risk of microbial colonization and infection. The aim of present study was to assess the frequency of pathogens colonizing CVC and to determine their susceptibility pattern to various antimicrobial agents. Materials and methods: A total of 253 samples of CVC from intensive care units (ICU) patients were received for culture during 2003. All microorganisms were identified by standard microbiological methods and the susceptibility to antimicrobial agents was determined according to NCCLS recommendations. Results: A total of 184 (72.7%) cultures were positive and 223 pathogens were isolated. Coagulase negative staphylococci (CNS) were the dominant isolates (24.7%), followed by Enterobacter spp. (12.1%), Pseudomonas spp. (11.7%), Enterococcus spp. (9.9%), Klebsiella spp. (8.6%), Candida spp. (7.6%), Acinetobacter spp. (7.6%), other Gram negative nonfermentative bacilli (5.8%), Serratia spp. (4.5%), Staphylococcus aureus (2.6%), Proteus mirabilis (2.2%), E. coli (1.8%) and Citrobacter spp. (0.9%). Meropenem (84.5%) and vancomycin (100%) remain the most effective antimicrobial agents against Gram negative and Gram positive bacteria, respectively. Conclusion: Gram negative bacilli and CNS are the commonest microorganisms colonizing CVC from ICU patients. The increasing resistance of the bacteria to antimicrobial agents is the major problem in spite of restricted policy of using antimicrobial agents in ICU.

Continuous glucose monitoring in the neonatal intensive care unit: need for practical guidelines – Authors' reply

2021 ◽  
Vol 5 (5) ◽  
pp. e16
Author(s):  
Kathryn Beardsall ◽  
Lynn Thomson ◽  
Isabel Iglesias-Platas ◽  
Mirjam M van Weissenbruch ◽  
Simon Bond ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Continuous Glucose Monitoring ◽  
Neonatal Intensive Care ◽  
Glucose Monitoring ◽  
Practical Guidelines
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