Grant V Bochicchio1, Stanley A Nasraway2, Laura J Moore3,4, Anthony P Furnary5,6,7, Eden A Nohra1, Kelly M Bochicchio1, James C Boyd8, David I Bruns8, Irl B Hirsch9, Jean-Charles Preiser10, James S Krinsley11. 1. Washington University, St. Louis School of Medicine, MO, USA. 2. Tufts University School of Medicine, Boston, MA, USA. 3. Department of Surgery, University of Texas, McGovern Medical School, Houston, TX, USA. 4. Memorial Hermann Hospital, Houston, TX, USA. 5. Providence St Vincent Medical Center, Portland, OR, USA. 6. Oregon Med Laser Center, Portland, OR, USA. 7. Portland Diabetes Project, OR, USA. 8. University of Virginia Health System, Charlottesville, VA, USA. 9. University of Washington School of Medicine, Seattle, WA, USA. 10. Erasme University Hospital, Brussels, Belgium. 11. Division of Critical Care, Stamford Hospital and Columbia Vagelos College of Physicians and Surgeons, CT, USA.
Abstract
BACKGROUND: The use of near-continuous blood glucose (BG) monitoring has the potential to improve glycemic control in critically ill patients. The MANAGE IDE trial evaluated the performance of the OptiScanner (OS) 5000 in a multicenter cohort of 200 critically ill patients. METHODS: An Independent Group reviewed the BG run charts of all 200 patients and voted whether unblinded use of the OS, with alarms set at 90 and 130 to 150 mg/dL to alert the clinical team to impending hypoglycemia and hyperglycemia, respectively, would have eliminated episodes of dysglycemia: hypoglycemia, defined as a single BG <70 mg/dL; hyperglycemia, defined as >4 hours of BG >150 mg/dL; severe hyperglycemia, defined as >4 hours of BG >200 mg/dL and increased glucose variability (GV), defined as coefficient of variation (CV) >20%. RESULTS: At least one episode of dysglycemia occurred in 103 (51.5%) of the patients, including 6 (3.0%) with hypoglycemia, 83 (41.5%) with hyperglycemia, 18 (9.0%) with severe hyperglycemia, and 40 (20.0%) with increased GV. Unblinded use of the OS with appropriate alarms would likely have averted 97.1% of the episodes of dysglycemia: hypoglycemia (100.0%), hyperglycemia (96.4%), severe hyperglycemia (100.0%), and increased GV (97.5%). Point accuracy of the OS was very similar to that of the point of care BG monitoring devices used in the trial. CONCLUSION: Unblinded use of the OS would have eliminated nearly every episode of dysglycemia in this cohort of critically ill patients, thereby markedly improving the quality and safety of glucose control.
BACKGROUND: The use of near-continuous blood glucose (BG) monitoring has the potential to improve glycemic control in critically illpatients. The MANAGE IDE trial evaluated the performance of the OptiScanner (OS) 5000 in a multicenter cohort of 200 critically illpatients. METHODS: An Independent Group reviewed the BG run charts of all 200 patients and voted whether unblinded use of the OS, with alarms set at 90 and 130 to 150 mg/dL to alert the clinical team to impending hypoglycemia and hyperglycemia, respectively, would have eliminated episodes of dysglycemia: hypoglycemia, defined as a single BG <70 mg/dL; hyperglycemia, defined as >4 hours of BG >150 mg/dL; severe hyperglycemia, defined as >4 hours of BG >200 mg/dL and increased glucose variability (GV), defined as coefficient of variation (CV) >20%. RESULTS: At least one episode of dysglycemia occurred in 103 (51.5%) of the patients, including 6 (3.0%) with hypoglycemia, 83 (41.5%) with hyperglycemia, 18 (9.0%) with severe hyperglycemia, and 40 (20.0%) with increased GV. Unblinded use of the OS with appropriate alarms would likely have averted 97.1% of the episodes of dysglycemia: hypoglycemia (100.0%), hyperglycemia (96.4%), severe hyperglycemia (100.0%), and increased GV (97.5%). Point accuracy of the OS was very similar to that of the point of care BG monitoring devices used in the trial. CONCLUSION: Unblinded use of the OS would have eliminated nearly every episode of dysglycemia in this cohort of critically illpatients, thereby markedly improving the quality and safety of glucose control.
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