Intensive Care Medicine

, 37:1517

Uncertainties in the measurement of blood glucose in paediatric intensive care: implications for clinical trials of tight glycaemic control

  • Helen Hill
  • Paul Baines
  • Paul Barton
  • Paul Newland
  • Dianne Terlouw
  • Mark Turner
Pediatric Original

DOI: 10.1007/s00134-011-2302-5

Cite this article as:
Hill, H., Baines, P., Barton, P. et al. Intensive Care Med (2011) 37: 1517. doi:10.1007/s00134-011-2302-5

Abstract

Purpose

In preparation for a tight glycaemic control (TGC) clinical trial we assessed the agreement between methods used to measure blood glucose in critically ill children.

Methods

Service evaluation comparing blood gas and main laboratory analysers with point-of-care (POC) devices PCX, ACCU-Chek and Hemocue.

Results

Two hundred forty-five samples from 157 children measured on 2–4 devices provided 790 values. Marked variation was evident in glucose values between devices, time between tests, sample (whole blood/plasma) and source; 39% of paired values had >20% difference. The decision to start insulin at 7 mmol/L differed depending on the device used for 33% of samples. At low glucose values (<4 mmol/L), differences up to 1.8 mmol/L were evident. The blood gas analyser read lower than all POC models and the laboratory analyser (less risk of undetected hypoglycaemia). An inverse relationship was evident between haematocrit (Hct) and glucose error using POC devices. PCX values for samples with Hct <30% were higher (85%), whereas those for Hct values >38% were lower (66%). Glycolysis occurred during transfer of samples to the laboratory. Using the PCX at the bedside resulted in 0.5 mmol/L mean difference higher than laboratory values; locating the PCX in the laboratory reduced this to 0.2 mmol/L.

Conclusions

Discrepancies between measurements may mask hypoglycaemia, and the potential benefits of controlling hyperglycaemia may not be achieved. Variation introduced by different devices, sample or source may have led to misclassification of treatment decisions contributing to the conflicting results of TGC studies.

Keywords

Blood glucose Point of care Tight glycaemic control Insulin Child Paediatric Intensive Critical Intensive insulin therapy 

Supplementary material

134_2011_2302_MOESM1_ESM.doc (354 kb)
Supplementary material 1 (DOC 353 kb)

Copyright information

© Copyright jointly held by Springer and ESICM 2011

Authors and Affiliations

  • Helen Hill
    • 1
  • Paul Baines
    • 2
  • Paul Barton
    • 3
  • Paul Newland
    • 3
  • Dianne Terlouw
    • 4
  • Mark Turner
    • 5
  1. 1.Alder Hey Children’s NHS FTLiverpoolUK
  2. 2.PICU Alder Hey Children’s NHS FTLiverpoolUK
  3. 3.Biochemistry Alder Hey Children’s NHS FTLiverpoolUK
  4. 4.Liverpool School of Tropical MedicineLiverpoolUK
  5. 5.University of LiverpoolLiverpoolUK

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