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Assessment of changes in blood glucose concentration with intravascular microdialysis

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Abstract

Blood glucose and its variability of is a major prognostic factor associated with morbidity. We hypothesized that intravenous microdialysis incorporated in a central venous catheter (CVC) would be interchangeable with changes in blood glucose measured by the reference method using a blood gas analyzer. Microdialysis and central venous blood glucose measurements were simultaneously recorded in high-risk cardiac surgical patients. The correlation between absolute values was determined by linear regression and the Bland–Altman test for repeated measurements was used to compare bias, precision, and limits of agreement. Changes in blood glucose measurement were evaluated by four-quadrant plot and trend interchangeability methods (TIM). In the 23 patients analyzed, the CVC was used as part of standard care with no complications. The correlation coefficient for absolute values (N = 99) was R = 0.91 (P < 0.001). The bias, precision and limits of agreement were − 9.1, 17.4 and − 43.2 to 24.9 mg/dL, respectively. The concordance rate for changes in blood glucose measurements (N = 77) was 85% with the four-quadrant plot. The TIM showed that 14 (18%) changes of blood glucose measurements were uninterpretable. Among the remaining 63 (82%) interpretable changes, 23 (37%) were interchangeable, 13 (20%) were in the gray zone, and 27 (43%) were not interchangeable. Microdialysis using a CVC appears to provide imprecise absolute blood glucose values with risk of insulin misuse. Moreover, only one third of changes in blood glucose measurements were interchangeable with the reference method using the TIM.

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Acknowledgements

The authors would like to thank Maquet Critical Care AB (Solna, Sweden) and especially Emmanuel Cheyron for providing all devices and monitoring equipment. The manufacturer provided no input to the design or conduct of the study or in the decision to submit the manuscript for publication.

Funding

This study was a standard care study and was not funded by any institution. All furniture (monitoring device and single-use material) was provided free of charge by Maquet Critical Care AB. The authors performed the present work in the course of their normal duties as full-time employees of public-sector healthcare institutions.

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Authors and Affiliations

  1. Pôle Réanimations Anesthésie SAMU/SMUR, Department of Anaesthesia and Intensive Care Medicine, Caen University Hospital de Caen, Avenue de la Côte de Nacre, CS 30001, 14000, Caen, France

    Marc-Olivier Fischer, Corentin Gouëzel, Jean-Louis Gérard & Jean-Luc Hanouz

  2. Department of Biology, University Hospital of Caen, Avenue de la Côte de Nacre, CS 30001, 14000, Caen, France

    Sabine Fradin

  3. Cardiac Surgery, University Hospital of Caen, Avenue de la Côte de Nacre, CS 30001, 14000, Caen, France

    Vladimir Saplacan

  4. Department of Anaesthesia and Intensive Care Medicine, Hôpital cardiologique Louis Pradel, Avenue du Doyen Lepine, 69 677, Lyon, France

    Jean-Luc Fellahi

  5. Faculty of Medicine, University of Lyon 1 Claude Bernard, 69 008, Lyon, France

    Jean-Luc Fellahi

Authors
  1. Marc-Olivier Fischer
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  2. Corentin Gouëzel
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  3. Sabine Fradin
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  4. Vladimir Saplacan
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  5. Jean-Louis Gérard
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  6. Jean-Luc Fellahi
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  7. Jean-Luc Hanouz
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Contributions

Conception and design: MOF, JLF, SF, JLH, JLG; Data collection: CG, MOF; Data analysis: MOF, VS; Drafting the manuscript: CG, MOF, JLF and Revision of the manuscript after critical review: all authors.

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Correspondence to Marc-Olivier Fischer.

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Fischer, MO., Gouëzel, C., Fradin, S. et al. Assessment of changes in blood glucose concentration with intravascular microdialysis. J Clin Monit Comput 32, 1135–1142 (2018). https://doi.org/10.1007/s10877-018-0111-x

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  • DOI: https://doi.org/10.1007/s10877-018-0111-x

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