title: Microcirculation and its relation to continuous subcutaneous glucose sensor accuracy in cardiac surgery patients in the intensive care unit.
abstract: OBJECTIVE
  Continuous glucose monitoring could be helpful for glucose regulation in critically ill patients; however, its accuracy is uncertain and might be influenced by microcirculation. We investigated the microcirculation and its relation to the accuracy of 2 continuous glucose monitoring devices in patients after cardiac surgery.
  
  
  METHODS
  The present prospective, observational study included 60 patients admitted for cardiac surgery. Two continuous glucose monitoring devices (Guardian Real-Time and FreeStyle Navigator) were placed before surgery. The relative absolute deviation between continuous glucose monitoring and the arterial reference glucose was calculated to assess the accuracy. Microcirculation was measured using the microvascular flow index, perfused vessel density, and proportion of perfused vessels using sublingual sidestream dark-field imaging, and tissue oxygenation using near-infrared spectroscopy. The associations were assessed using a linear mixed-effects model for repeated measures.
  
  
  RESULTS
  The median relative absolute deviation of the Navigator was 11% (interquartile range, 8%-16%) and of the Guardian was 14% (interquartile range, 11%-18%; P = .05). Tissue oxygenation significantly increased during the intensive care unit admission (maximum 91.2% [3.9] after 6 hours) and decreased thereafter, stabilizing after 20 hours. A decrease in perfused vessel density accompanied the increase in tissue oxygenation. Microcirculatory variables were not associated with sensor accuracy. A lower peripheral temperature (Navigator, b = -0.008, P = .003; Guardian, b = -0.006, P = .048), and for the Navigator, also a higher Acute Physiology and Chronic Health Evaluation IV predicted mortality (b = 0.017, P < .001) and age (b = 0.002, P = .037) were associated with decreased sensor accuracy.
  
  
  CONCLUSIONS
  The results of the present study have shown acceptable accuracy for both sensors in patients after cardiac surgery. The microcirculation was impaired to a limited extent compared with that in patients with sepsis and healthy controls. This impairment was not related to sensor accuracy but the peripheral temperature for both sensors and patient age and Acute Physiology and Chronic Health Evaluation IV predicted mortality for the Navigator were.
authors.affiliation: Department of Internal Medicine, Academic Medical Centre, Amsterdam, The Netherlands. Electronic address: s.e.siegelaar@amc.uva.nl.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Siegelaar
authors.forename: Temo
authors.initials: T
authors.lastname: Barwari
authors.forename: Jeroen
authors.initials: J
authors.lastname: Hermanides
authors.forename: Peter H J
authors.initials: PH
authors.lastname: van der Voort
authors.forename: Joost B L
authors.initials: JB
authors.lastname: Hoekstra
authors.forename: J Hans
authors.initials: JH
authors.lastname: DeVries
mesh_terms: D018806:APACHE; D000367:Age Factors; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D001831:Body Temperature; D006348:Cardiac Surgical Procedures; D003325:Coronary Care Units; D003422:Critical Care / Q000379:methods*; D004867:Equipment Design; D045604:Extracellular Fluid / Q000378:metabolism*; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000295:instrumentation; D011237:Predictive Value of Tests; D011446:Prospective Studies; D019265:Spectroscopy, Near-Infrared; D040521:Subcutaneous Tissue / Q000098:blood supply*; D014159:Transducers
chemical_list: D001786:Blood Glucose
keywords: 23.1; 41.1; APACHE IV PM; Acute Physiology and Chronic Health Evaluation IV predicted mortality; CGM; HI; ICU; IQR; MFI; PPV; PVD; RAD; SDF; StO(2); continuous glucose monitoring; heterogeneity index; intensive care unit; interquartile range; microvascular flow index; perfused vessel density; proportion of perfused vessels; relative absolute deviation; sidestream dark-field; tissue oxygenation