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Uncertainties in the measurement of blood glucose in paediatric intensive care: implications for clinical trials of tight glycaemic control

Hill, Helen, Baines, Paul, Barton, Paul, Newland, Paul, Terlouw, Anja and Turner, Mark (2011) 'Uncertainties in the measurement of blood glucose in paediatric intensive care: implications for clinical trials of tight glycaemic control'. Intensive Care Medicine, Vol 37, Issue 9, pp. 1517-1524.

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Abstract

Abstract Purpose: In preparation for a tight glycaemic control (TGC) clinical trial we assessed the agreement
between methods used to measure blood glucose in critically ill children.
Methods: Service evaluation comparing blood gas and main laboratory analysers with point-ofcare (POC) devices PCX, ACCUChek and Hemocue. Results: Two hundred forty-five samples from 157 children measured on 2–4 devices
provided 790 values. Marked variation was evident in glucose values between devices, time between tests, sample (whole blood/plasma) and source; 39% of paired values had
[20% difference. The decision to start insulin at 7 mmol/L differed depending on the device used for 33% of samples. At low glucose values (\4 mmol/L), differences up to 1.8 mmol/L were evident. The blood gas analyser read lower than all POC models and the laboratory analyser (less risk of undetected hypoglycaemia). An inverse relationship was
evident between haematocrit (Hct) and glucose error using POC devices. PCX values for samples with Hct \30% were higher (85%), whereas those for Hct values[38% were lower (66%). Glycolysis occurred during transfer of samples to the
laboratory. Using the PCX at the bedside resulted in 0.5 mmol/L mean difference higher than laboratory values; locating the PCX in the laboratory reduced this to 0.2 mmol/L.
Conclusions: Discrepancies between measurements may mask
hypoglycaemia, and the potential benefits of controlling hyperglycaemia may not be achieved. Variation introduced by different devices, sample or source may have led to
misclassification of treatment decisions contributing to the conflicting results of TGC studies.

Item Type: Article
Uncontrolled Keywords: Blood glucose; Point of care; Tight glycaemic control; Insulin; Child; Paediatric; Intensive; Critical; Intensive insulin therapy
Subjects: QY Clinical Pathology > Blood. Blood Chemistry > QY 450 Blood chemistry
WS Pediatrics > Diseases of Children and Adolescents > General Diseases > WS 205 Pediatric emergencies
Faculty: Department: Groups (2002 - 2012) > Child & Reproductive Health Group
Digital Object Identifer (DOI): https://doi.org/10.1007/s00134-011-2302-5
Depositing User: Helen Wong
Date Deposited: 01 Nov 2011 16:53
Last Modified: 06 Feb 2018 13:04
URI: http://archive.lstmed.ac.uk/id/eprint/2387

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