Anemia is present in over 70% of ICU patients and typically worsens the longer a patient is in the hospital. Commonly used drugs such as acetaminophen, dopamine, acetylcysteine, icodextrin, and ascorbic acid are known to cause falsely elevated glucose readings in many meters. These can be endogenous (anemia, hypotension), or exogenous such as medications. 11Ī significant factor accounting for poor performance in some BGMS is from interfering agents. Food and Drug Administration (FDA) for use in critically ill patients. 9,10 In fact, only one BGMS has been approved by the U.S. Many POC blood glucose monitoring systems (BGMS) simply are not accurate enough in this patient population to be trusted. Point-of-care testing (POCT) appears to be an obvious answer for accomplishing this, but it is not as simple as it appears. The cornerstone of proper glycemic control is accurate and timely measurement of blood glucose. Point-of-care measurement of blood glucose 7 Importantly, in non-diabetic patients with COVID-19, those with uncontrolled hyperglycemia had a mortality rate of over 40%. Preexisting diabetes increases morbidity and mortality in COVID-19 patients, and well controlled blood glucose in this population is associated with improved outcomes. 5 Glucose control is also being increasingly recognized as a prognostic factor in COVID-19 patients. There is also observational evidence that dysglycemia is actually the primary cause of poor outcomes rather than merely a marker for more severe disease. 1-3 Although there is debate about how “tight” this control should be, there is consensus that it is beneficial. There is now quite a bit of data that shows improved outcomes with insulin therapy in critically ill patients. One such factor is glycemic control.Īlthough controlling blood sugar is an obvious necessity for diabetic patients, glycemic control is a component of care in most, if not all, critically ill patients as dysglycemia is prevalent in these patients. ![]() ![]() To say that only patients residing in the ICU require this stepped-up level of care is to potentially underestimate their disease severity and overlook factors which may adversely affect outcomes. These patients require specialized, timely, and individualized care to achieve the best outcomes. Very sick patients are often not in intensive care units, but throughout the hospital: emergency departments, post-anesthesia care units, operating rooms, and labor and delivery. What makes a patient “critically ill”? The term gets used often, but it can be difficult to define.Ĭertainly, being in an intensive care unit (ICU) should satisfy this, but, paradoxically, not every patient in the ICU is critically ill, and patients outside of the ICU setting have the potential to be considered critically ill.
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