Intermittent, capillary-based measurement is labor intensive, and large glucose fluctuations may go unnoticed between readings ( 2, 5, 12, 13). Hypoglycemia is thus considered the primary obstacle to achieving tight blood glucose control in critically ill patients ( 11).Īccurate monitoring of blood glucose is a key aspect of critical care, in which early clinical signs and symptoms of both hypo- and hyperglycemia can be difficult to identify given the sedation of patients who are critically ill. However, intensive insulin therapy can increase the risk of hypoglycemia in critically ill patients, which carries an independent risk of increased morbidity and mortality and is associated with significantly extended ICU stays ( 8, 10). The landmark Leuven trials ( 6, 7) suggested that strict glycemic control via intensive insulin therapy could reduce morbidity and mortality in critically ill patients, prompting intensive therapy strategies to achieve normoglycemia in ICU settings ( 8, 9). Stress-induced hyperglycemia is commonly observed in critically ill patients and may be experienced by up to 90% of patients in intensive care units (ICUs), including those without a history of diabetes mellitus ( 1–5). The ACCU-CHEK Inform II system demonstrated clinically acceptable performance and high sensitivity and specificity, with low risk of insulin-dosing error, furthering insight into the use of POC glucose monitoring devices in critical care. Performance was evaluated against a higher-order perchloric acid hexokinase method (linked to isotope dilution GC-MS), and the clinical implications of using the system were assessed via Parkes error grid, Monte Carlo simulation, and sensitivity and specificity analyses. This study investigated the use of the ACCU-CHEK ® Inform II system for point-of-care (POC) glucose monitoring in a large population of critically ill adult, pediatric, and neonatal patients in US hospital settings.
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