Monitorización de la glucemia en el paciente crítico adulto: tipo de muestra y método de análisis. Revisión sistemática y metanálisis

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2024-01-01 DOI:10.1016/j.enfi.2023.02.003

S. Arias-Rivera PhDc, MSN, RN , M. Raurell-Torredà PhD, MSN, RN , R.J. Fernández-Castillo PhDc, MSN, RN , C. Campos-Asensio BPharm, MLS , I.J. Thuissard-Vasallo MsC, PhD , C. Andreu-Vázquez PhD, MsC, MvD , M.E. Rodríguez-Delgado MsC, RN

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引用次数: 0

Abstract

Introduction

The clinical guideline for the management of sepsis recommends using arterial blood samples for glycaemic control. A multicentre study in 86 Spanish intensive care units revealed that 85.4% of these used capillary puncture.

Objective

To analyse the reliability of glycaemia by comparing different blood samples (arterial, venous, capillary) and instruments (glucometers, gasometers, central laboratory). Secondarily, to estimate the effect of confounding variables and the performance of measuring instruments as determined by different quality standards.

Methodology

Systematic review and meta-analysis with search in PubMed, CINAHL and Embase databases in September-2021 and September-2022, with no time or language limits. Grey literature sources: DART-Europe, OpenGrey and Google Scholar. Results summarised by qualitative (description of results, study characteristics) and quantitative (meta-analysis to assess standardised mean difference) synthesis. Methodological quality of articles assessed with Quality Assessment of Diagnostic Accuracy Studies-2. Protocol: https://osf.io/ DOI 10.17605/OSF.IO/T8KYP.

Results

A total of 32 articles and 5451 patients were included. No discrepancies were obtained between arterial glucometer vs. laboratory samples (bias [95%CI]: 0.01 [−0.12 to 0.14] mg/dL). In contrast, arterial samples with a gasometer did significantly overestimate (bias [95%CI]: 0.12 [0.01 to 0.24] mg/dL). The same trend is seen in capillaries with a glucometer, although not significantly (bias [95%CI]: 0.07 [−0.02 to 0.15] mg/dL). There is discrepancy between studies on the effect of haematocrit and acid-base balance. The greatest consensus is on the poor agreement of glucometer with capillary vs. laboratory samples in the presence of shock and vasopressor support, renal failure or during vitamin C treatment.

Conclusions

The evidence to date recommends the use of arterial blood with a blood glucose meter for better reliability of glycaemic analysis and less effect of possible confounding variables, frequently present in the critically ill adult patient.

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成年重症患者的血糖监测：样本类型和分析方法。系统回顾和荟萃分析

导言脓毒症临床治疗指南建议使用动脉血样本控制血糖。目的通过比较不同的血液样本（动脉血、静脉血、毛细血管血）和仪器（血糖仪、气压计、中心实验室），分析血糖控制的可靠性。方法在 2021 年 9 月和 2022 年 9 月在 PubMed、CINAHL 和 Embase 数据库中进行系统回顾和荟萃分析，无时间和语言限制。灰色文献来源：DART-Europe, OpenGrey 和 Google Scholar。通过定性（结果描述、研究特点）和定量（评估标准化平均差异的荟萃分析）综合总结结果。采用诊断准确性研究质量评估-2对文章的方法学质量进行评估。协议：https://osf.io/ DOI 10.17605/OSF.IO/T8KYP.结果共纳入32篇文章和5451名患者。动脉血糖仪样本与实验室样本之间无差异（偏差[95%CI]：0.01 [-0.12 至 0.14] mg/dL）。与此相反，使用气压计采集的动脉样本则明显偏高（偏差[95%CI]：0.12 [0.01 至 0.24] mg/dL）。使用血糖仪对毛细血管样本进行测量也有同样的趋势，但并不明显（偏差[95%CI]：0.07 [-0.02 至 0.15] mg/dL）。关于血细胞比容和酸碱平衡的影响，不同研究之间存在差异。结论：迄今为止的证据表明，建议使用动脉血和血糖仪进行血糖分析，以提高血糖分析的可靠性，并减少可能存在的混杂变量的影响，这些混杂变量在重症成年患者中经常出现。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.