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Title: Monitorización de la glucemia en el paciente crítico adulto: tipo de muestra y método de análisis. Revisión sistemática y metanálisis. Blood glucose monitoring in critically ill adult patients: Type of sample and method of analysis. Systematic review and meta-analysis
Unidad de investigación de enfermería, Hospital Universitario de Getafe, Getafe, Madrid, España
Departamento de Enfermería Fundamental y Médico Quirúrgica, Universitat de Barcelona, Barcelona, España
Unidad de Cuidados Intensivos, Hospital Universitario Virgen Macarena; Departamento de Enfermería, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, Sevilla, España
Biblioteca Médica, Hospital Universitario de Getafe, Getafe, Madrid, España
Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España
Unidad de Cuidados Intensivos, Hospital Universitario Clínico San Cecilio, Granada, España
Issue Date: 17-May-2023
Publisher: Elsevier BV
Citation: Arias-Rivera S, Raurell-Torredà M, Fernández-Castillo RJ, Campos-Asensio C, Thuissard-Vasallo IJ, Andreu-Vázquez C, et al. Blood glucose monitoring in critically ill adult patients: Type of sample and method of analysis. Systematic review and meta-analysis. Enferm Intensiva 2023.
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: 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.
Rights: info:eu-repo/semantics/openAccess
Atribución 3.0 España
ISSN: 1130-2399
Appears in Collections:Hospitales > H. U. de Getafe > Artículos

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