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Tight Glycemic Control in the ICU

ter that has the highest correlation with lab values in the euglycemic range to help prevent hypoglycemia.

Continuous glucose monitors will be the optimal solution for avoiding hypoglycemia and decreasing workload in the ICU. Many research groups have been working on their development. There is an approved device for detecting glycemic excursions in outpatients with diabetes that has shown promise in monitoring critically ill patients. The Continuous Glucose Monitoring System (CGMS, Medtronic MiniMed) utilizes a subcutaneous sensor implanted in the abdomen. However, in its current format, the CGMS does not provide real-time monitoring. GluCath (GluMetrics, Inc.) is a catheter device in the development pipeline for continuous monitoring of hospitalized patients. The device consists of an optical fiber to which an optical glucose sensor is applied. The sensor is a fluorescent chemical complex immobilized in a thin-film hydrogel that is permeable to glucose.

FDA approved glucose monitoring systems for the ICU include the HemoCue Glucose 201 DM System, LifeScan SureStepFlexx Professional Blood Glucose Management System, and Roche Diagnostics Accu-Chek Inform System. All 3 systems have handheld devices that provide quantitative glucose measurement of capillary, venous, arterial and neonatal whole blood, and yield plasma calibrated results. TELCOR provides connectivity for the 3 systems, and RALS-Plus provides connectivity for Roche and LifeScan.

The HemoCue Glucose 201 DM System provides the glucose analyzer, docking station, microcuvettes, and 201 DM software. The glucose test system is based on the glucose dehydrogenase method and consists of the analyzer and a unique disposable microcuvette, which serves as pipette, reaction vessel, and measuring cuvette. Approximately 5 l blood is drawn into the cuvette cavity by capillary action and spontaneously mixed with dried reagents on the inner walls. The cuvette is then placed into the
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