Published online September 1, 2006
PEDIATRICS Vol. 118 No. 3 September 2006, pp. 1176-1184 (doi:10.1542/peds.2006-0347)

This Article Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services E-mail this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Web of Science (4) Citing Articles via Google Scholar Google Scholar Articles by Piper, H. G. Articles by Agus, M. S.D. Search for Related Content PubMed PubMed Citation Articles by Piper, H. G. Articles by Agus, M. S.D. Related Collections Surgery Social Bookmarking                         What's this?

STATE-OF-THE-ART REVIEW ARTICLE

Real-Time Continuous Glucose Monitoring in Pediatric Patients During and After Cardiac Surgery

Hannah G. Piper, MD^a, Jamin L. Alexander, BA^b, Avinash Shukla, MD^c, Frank Pigula, MD^d, John M. Costello, MD^e, Peter C. Laussen, MD^e, Tom Jaksic, MD, PhD^a and Michael S.D. Agus, MD^b

^a Departments of Surgery
^b Medicine
^c Anesthesia
^d Cardiovascular Surgery
^e Cardiology, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts

ABSTRACT

OBJECTIVES. Given the demonstrated benefit of euglycemia in critically ill patients as well as the risk for hypoglycemia during insulin infusion in children, we sought to validate a subcutaneous sensor for real-time continuous glucose monitoring in pediatric patients during and after cardiac surgery.

METHODS. Children up to 36 months of age who were undergoing cardiac bypass surgery were recruited. After anesthetic induction, a continuous glucose-monitoring system sensor (CGMS, Medtronic Minimed, Northridge, CA) was inserted subcutaneously. Sensors remained in place for up to 72 hours. Arterial blood glucose was measured intermittently in the central laboratory (Bayer Rapidlab 860, Tarrytown, NY). Sensor data, after prospective calibration with 6-hourly laboratory values using the proprietary Medtronic Minimed Guardian RT algorithm, were compared with all laboratory glucose values. Statistical analysis was performed to test whether sensor performance was affected by body temperature, inotrope dose, or body-wall edema.

RESULTS. Twenty patients were enrolled in the study for a total of 40 study days and 246 paired sensor and laboratory glucose values. Consensus error grid analysis demonstrated that 72.0% of sensor value comparisons were within zone A (no effect on clinical action), and 27.6% of comparisons were within zone B (altered clinical action of little or no effect on outcome), with a mean absolute relative deviation of 17.6% for all comparisons. One comparison (0.4%) was in zone C (altered clinical action likely to affect outcome). No significant correlations were found between sensor performance and body temperature, inotrope dose, or body-wall edema. All patients tolerated the sensors well without bleeding or tissue reaction.

CONCLUSIONS. Guardian RT real-time subcutaneous blood glucose measurement is safe and potentially useful for continuous glucose monitoring in critically ill children. Subcutaneous sensors performed well in the setting of hypothermia, inotrope use, and edema. These sensors facilitate identifying and following the effects of interventions to control blood glucose.

---

Key Words: glucose monitoring • cardiac surgery • hyperglycemia

Abbreviations: CGMS—continuous glucose-monitoring system • CICU—cardiac ICU • MARD—mean absolute relative difference

---

Accepted Apr 28, 2006.

CiteULike    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				A. Polito, R. R. Thiagarajan, P. C. Laussen, K. Gauvreau, M. S.D. Agus, M. A. Scheurer, F. A. Pigula, and J. M. Costello Association Between Intraoperative and Early Postoperative Glucose Levels and Adverse Outcomes After Complex Congenital Heart Surgery Circulation, November 25, 2008; 118(22): 2235 - 2242. [Abstract] [Full Text] [PDF]

				H. E. Skillman and P. E. Wischmeyer Nutrition Therapy in Critically Ill Infants and Children JPEN J Parenter Enteral Nutr, September 1, 2008; 32(5): 520 - 534. [Abstract] [Full Text] [PDF]