Monitoring of glucose concentration in critical patients, comparing arterial blood glucose concentrations and interstitial glucose concentration measured by microdialysis technique

Czech version

Authors: J. Křemen ¹; J. Bláha ²; M. Matias ²; K. Anderlová ¹; M. Ellmerer ³; J. Plank ³; T. Pieber ³; Š. Svačina ¹; M. Haluzík ¹
Authors‘ workplace: III. interní klinika 1. lékařské fakulty UK a VFN, Praha, přednosta prof. MUDr. Štěpán Svačina, DrSc., MBA ¹; Klinika anesteziologie, resuscitace a intenzivní medicíny 1. lékařské fakulty UK a VFN, Praha, přednosta MUDr. Martin Stříteský, CSc. ²; Interní klinika Lékařské Univerzity, Graz, Rakousko, přednosta prof. MUDr. Ernst Pilger ³
Published in: Vnitř Lék 2006; 52(9): 777-781
Category: Original Contributions

Overview

Introduction:
Recent studies have shown that normalization of blood glucose in critically ill patients by intensive insulin therapy significantly decreases their mortality and morbidity. The aim of our study was to compare interstitial glucose concentrations in subcutaneous adipose tissue (measured by microdialysis technique) and arterial blood glucose concentrations to test the suitability of subcutaneous adipose tissue for long-term placement of biosensors for glucose measurement in critically ill patients.

Patients and methods:
20 patients (16 men and 4 women) after cardiac surgery hospitalized at postoperative intensive care unit were included into the study. Mean age was 68 ± 10 years, BMI was 28.3 ± 3.9 year. Only patients with glycemia higher than 6.7 mmol/l at a time of admission to the ICU were included. Samples for measurement of interstitial glucose concentrations were collected in 60 minutes intervals during 48 hours using microdialysis of the subcutaneous adipose tissue. Perfusion fluid was 5% mannitol, perfusion rate was 1 µl/min. Arterial blood glucose concentration was measured in 60 minutes intervals, absolute concentrations of interstitial glucose were calculated using ionic reference technique.

Results:
Mean arterial glucose concentration during the study was 6.7 ± 0.56 mmol/l, absolute concentration of glucose in interstitial fluid was 3.55 ± 0.58 mmol/l. Mean correlation coefficient between arterial and interstitial concentrations was 0.77 ± 0.15.

Conclusion:
Our study demonstrated good correlation between interstitial glucose concentrations in subcutaneous adipose tissue and arterial blood glucose concentrations in post-cardiac surgery patients. Further studies are needed to evaluate this relationship in patients with more severely disturbed perfusion of subcutaneous adipose tissue.

Keywords:
microdialysis - glycemia - interstitial fluid - critical illness

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