POCT ISTAT GEN PNL TRIAL

There are two important methods to express the accuracy of POC meters. This is called pre-analytical error, and practitioners must be careful to make sure this is not the cause of unexpectedly low glucose results. One of the most common errors in measurement results from sample dilution from intravenous fluid or arterial line flush. In comparison, CLD and BGM samples are analyzed routinely on arterial or venous blood.

POC meters most commonly use capillary blood obtained from the fingertip although arterial or venous blood is used on occasion. Furthermore, a number of drugs interfere with their accuracy (see below). 5 Each technology has advantages and disadvantages, but none approach the accuracy of the CLD. The commercially available POC meters use one of several enzyme systems for glucose measurements. 6 This review will present the overall accuracy profiles, common interferences, and recent regulation of these POC glucose meters. In addition, there are a number of interferences that are unique to these meters. Although they have distinct advantages compared to CLDs and BGMs, including using very little blood volume (~5 microliters), speed of measurement (~5 seconds for testing) and being inexpensive (total direct cost ~$0.75/test), they are not nearly as accurate as CLD measurements. 5 Until very recently these meters were the exact same devices used by patients with diabetes to measure their blood glucose at home. In the perioperative environment, the most commonly used system is the POC meter. There are a number of options for testing blood glucose levels in the hospital including the central laboratory device (CLD), blood gas machines (BGM), and point-of-care (POC) devices. The general agreement is for a perioperative glucose target <180 mg/dL and the avoidance of hypoglycemia. Furthermore, learned societies and regulatory agencies have relaxed the goals for acute care glucose manangement. The end result of these and other well-known publications was the increased scrutiny of the methods, accuracy, and interferences with blood glucose measurement in the hospital. The NICE-SUGAR investigators reported an increase in mortality in the intense insulin therapy group (27.5% vs 24.9% at 90 days) and a much higher incidence of hypoglycemia. Subsequently, a larger, multicenter, multinational NICE-SUGAR study, which was published in 2009, 3 investigated mortality in medical and surgical ICU patients by comparing a cohort with a tight glucose target of 81–108 mg/dL to a conventional goal group of <180 mg/dL. Ultimately, this study was shown to have limitations, but was credited with starting the wave of tight glucose control ICU algorithms, which appeared poised to engulf intraoperative glycemic management. This investigation compared controlling blood glucose between 80 and 110 mg/dL to a conventional treatment group (starting insulin infusions when the glucose was greater than 215 mg/dL). 4.6% at 12 months) and morbidity in a surgical intensive care unit (ICU) population dominated by cardiac surgical patients. Van den Berghe’s group 2 reported reduced mortality (8 vs.

POCT ISTAT GEN PNL TRIAL

In particular, the single-center intensive insulin therapy trial from Dr. 1 Studies such as this and others that reported changes in patient outcomes secondary to controlling perioperative glucose concentrations drove increased blood glucose monitoring in the acute care setting. Hyperglycemia, defined in one study as 2 or more episodes of either a fasting glucose of 126 mg/dL or a random reading of 200 mg/dL, or greater, was shown to be a strong predictor of in-hospital mortality. We believe that the technology we use in our practice has not only been thoroughly vetted by monitor and device manufacturers and the FDA, but also by academic physicians who have tested, compared these technologies to other systems, and published the results. Anesthesia care providers rely heavily on monitors and diagnostic devices for the safe passage of our patients.

Poct istat gen pnl