Pilot study of the accuracy of bedside glucometry in the intensive care unit

Objective To evaluate the accuracy of bedside glucometry among critically ill patients. Design Prospective audit, with sequential specimen collection. Setting Thirty-two-bed cardiovascular, neurosurgical, and medical-surgical intensive care unit in a single Canadian center. Patients Ten critically ill adults, who were sequentially followed during their intensive care unit stay. Eight had diabetes mellitus, and three were in shock. Measurements and Main Results Repeat arterial blood samples were obtained by the attending nurse, who withdrew a portion of the sample and performed reflectance glucometry at the bedside. The remainder was immediately sent in a vacuum-sealed plasma separation tube to the hospital laboratory, and analyzed using a conventional plasma glucose analyzer by a laboratory technologist. Sequential samples were taken at intervals of at least 12 hrs of one other. A total of 105 arterial glucose pairs were obtained. There was a significant correlation between the laboratory and glucometry determined glucose concentrations (intraclass correlation coefficient = 0.86, p < .0001). The overall average laboratory-glucometry glucose difference was −0.04 mmol/L (95% confidence interval [CI] −2.3–2.2 mmol/L). Five out of 105 values (4.8%) lay beyond these confidence bounds. The square of the Pearson correlation coefficient (r2) between the mean glucose level and the laboratory-glucometry glucose difference was not significant (0.01, 95% CI 0.005–0.04;p = .22), suggesting the absence of any trend between rising glucose concentration and the laboratory-glucometry difference. Conclusions Bedside glucose testing of arterial whole blood samples may be an accurate alternative to laboratory plasma glucose measurement among critically ill adults, within approximately 2.3 mmol/L of certainty. Because previous studies have suggested that this bedside technique may be prone to a moderate degree of error among patients in shock as well as those with an abnormal blood pH or hematocrit, larger studies are needed to confirm our findings.