OBJECTIVE Glycemia management in critical care is posing a challenge in frequent measuring and adequate insulin dose adjustment. In recent years, continuous glucose measurement has gained accuracy and reliability in outpatient and inpatient settings. The aim of this study was to assess the feasibility and accuracy of real-time continuous glucose monitoring (CGM) in ICU patients after major abdominal surgery. RESEARCH DESIGN AND METHODS We included patients undergoing pancreatic surgery and solid organ transplantation (liver, pancreas, islets of Langerhans, kidney) requiring an ICU stay after surgery. We used a Dexcom G6 sensor, placed in the infraclavicular region, for real-time CGM. Arterial blood glucose measured by the amperometric principle (ABL 800; Radiometer, Copenhagen, Denmark) served as a reference value and for calibration. Blood glucose was also routinely monitored by a StatStrip bedside glucose meter. Sensor accuracy was assessed by mean absolute relative difference (MARD), bias, modified Bland-Altman plot, and surveillance error grid for paired samples of glucose values from CGM and acid-base analyzer (ABL). RESULTS We analyzed data from 61 patients and obtained 1,546 paired glucose values from CGM and ABL. Active sensor use was 95.1%. MARD was 9.4%, relative bias was 1.4%, and 92.8% of values fell in zone A, 6.1% fell in zone B, and 1.2% fell in zone C of the surveillance error grid. Median time in range was 78%, with minimum (<1%) time spent in hypoglycemia. StatStrip glucose meter MARD compared with ABL was 5.8%. CONCLUSIONS Our study shows clinically applicable accuracy and reliability of Dexcom G6 CGM in postoperative ICU patients and a feasible alternative sensor placement site.

中文翻译：

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腹部手术和实体器官移植后危重患者实时连续血糖监测的准确性和可行性

目的 重症监护中的血糖管理对频繁测量和适当调整胰岛素剂量提出了挑战。近年来，连续血糖测量在门诊和住院环境中获得了准确性和可靠性。本研究的目的是评估腹部大手术后 ICU 患者实时连续血糖监测 (CGM) 的可行性和准确性。研究设计和方法 我们纳入了接受胰腺手术和实体器官移植（肝脏、胰腺、胰岛、肾脏）且手术后需要入住 ICU 的患者。我们使用放置在锁骨下区域的 Dexcom G6 传感器进行实时 CGM。通过安培原理（ABL 800；Radiometer，哥本哈根，丹麦）测量的动脉血糖作为参考值并用于校准。还通过 StatStrip 床边血糖仪定期监测血糖。通过平均绝对相对差 (MARD)、偏差、修正的 Bland-Altman 图和来自 CGM 和酸碱分析仪 (ABL) 的成对葡萄糖值样本的监测误差网格来评估传感器准确性。结果 我们分析了 61 名患者的数据，并从 CGM 和 ABL 中获得了 1,546 个配对的葡萄糖值。主动传感器使用率为 95.1%。MARD 为 9.4%，相对偏差为 1.4%，92.8% 的值落在监测误差网格的 A 区，6.1% 落在 B 区，1.2% 落在 C 区。范围内的中位时间为 78%，其中发生低血糖的时间最短（＜1%）。StatStrip血糖仪MARD与ABL相比为5.8%。结论 我们的研究表明 Dexcom G6 CGM 在术后 ICU 患者中的临床适用准确性和可靠性以及可行的替代传感器放置位置。