GLYCAEMIC CONTROL PRACTICE DIFFERS GREATLY IN INTENSIVE CARE UNITS
There is a significant variability in glycaemic control practices in intensive care units (ICUs) throughout northwest Europe, a recent study has confirmed.
Sphere Medical, specialist in critical care monitoring and diagnostics equipment, has recently published a scientific poster discussing “A comparative survey of glycaemic control practice in the UK, Germany and BeNeLux” which they discussed at the Intensive Care Society State of the Art Meeting.
Elevated blood glucose is a widely recognised response to critical illness, with around two thirds of patients admitted to the intensive care unit requiring intravenous insulin therapy (IIT) in order to avoid hyperglycaemia. However, IIT also carries the risk of hypoglycaemic episodes and injury. Sphere’s study involved Intensivists from 90 adult intensive care units (ICU) and aimed to understand the current practices, protocols and challenges of glycaemic control practice using IIT.
The study confirmed that there are still controversies over what constitutes optimal glucose management in critical care, resulting in its finding that care protocols remain highly variable across northwest European ICUs. 80% of Intensivists surveyed also cited problems with implementing their adopted glycaemic control protocols for a number of reasons.
Dr Gavin Troughton, Sphere Medical, said: “Blood testing is at the heart of many of these issues. Frequent blood glucose monitoring is essential for optimally managing insulin therapy, and protocols often require hourly measurement of blood glucose until patient stability is achieved. Any variations that could affect glucose levels, such as insulin or feed changes, require reverting to hourly measurement until stability is evident.”
Consequently, the study found that nurse dependency and time taken to undertake the frequent blood glucose monitoring, essential for optimally
8 | Tomorrow’s Laboratories
KYOCERA OPTICAL BLOOD-FLOW SENSOR IS AMONG WORLD’S SMALLEST FOR WEARABLE DEVICES AND SMARTPHONES
Kyocera Corporation has announced that it has developed one of the smallest known optical blood-flow sensors, which measures the volume of blood flow in subcutaneous tissue.
With the sensor, Kyocera is researching a variety of mobile health (mHealth) applications, such as monitoring stress levels or preventing dehydration, heatstroke and altitude sickness, by studying trends or changes in blood-flow volume as alerts for these conditions and developing algorithms for detection.
Leveraging Kyocera’s expertise in miniaturisation, the sensor — only 1mm high, 1.6mm long and 3.2mm wide — is designed for use in small devices such as mobile phones and wearable devices. The company will offer sensor module samples starting April 2017, and aims to commercialise the technology as a device by March 2018.
The wearable device market has expanded substantially in recent years, focused primarily on health and fitness. New mHealth applications are being developed
monitoring IIT, was the most commonly cited issue when implementing protocols. Although arterial blood gas analysers (BGA) are the gold standard for measuring glucose samples, the survey found only 70% of tests were made using this method for IIT monitoring. This means that there is still a widespread use of capillary samples and test strips (potentially to reduce time to result and workloads) that can lead to significantly biased results, or BGA testing may not be
for a wide range of healthcare applications including chronic diseases, eldercare and wellness, and global shipments of healthcare wearables are expected to rise from 2.5 million units in 2016 to 97.6 million units in 2021.
Kyocera, which provides a wide range of components for smartphones and wearables, has been developing slimmer, smaller products to support higher functionality in more compact devices. The company developed this sensor as an integrated module, incorporating the laser diode and photodiode into a single ceramic package, based on its established expertise in miniaturisation technologies.
Devices equipped with this new sensor will be able to measure blood-flow volume in subcutaneous tissue by placing the device in contact with an ear, finger or forehead. When light is reflected on blood within a blood vessel, the frequency of light varies — called a frequency or Doppler shift — according to the blood-flow velocity. The new sensor utilizes the relative shift in frequency (which increases as blood flow accelerates) and the strength of the reflected light (which grows stronger when reflected off a greater volume of red blood cells) to measure blood-flow volume.
Featuring a high signal-to-noise ratio (S/N), small size and low power consumption (output: 0.5mW), the sensor can be easily integrated into a smartphone or wearable device for mHealth applications.
undertaken as often as necessary.
To overcome the issues arising around blood testing for IIT, a number of continuous and intermittent systems are now commercially available for glucose monitoring in ICUs. For example, the next generation Proxima patient-dedicated blood gas analysis system (Sphere Medical, Cambridge, UK) now allows rapid measurement of glucose levels directly at the bedside.
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