Accuracy of point-of-care capillary blood sugar measurements in critically ill patients: An observational study.

Background: Accurately monitoring blood glucose levels is vital for critically ill individuals. Point-of-care (POC) glucose meters are commonly used in local intensive care units (ICUs). This study aimed to assess the precision of POC glucose meter readings in critically ill individuals with specific evaluation in patients with and without shock against the reference standard of venous blood glucose measurements. Methods: An observational study was done on adult patients admitted in the ICU at a teaching institution. Capillary blood samples were collected from the patient's fingertip using lancet device with aseptic measures. The sample was analyzed using the GlucoCare Sense Glucometer (RMD Mediaids Limited, Taiwan). At the same time, 2 ml of blood was drawn from the patient's peripheral veins and analyzed by glucose oxidase-peroxidase method as reference. Results: POC glucose measurements averaged 140 ± 20.23 mg/dl, while laboratory values were recorded as 116.10 ± 17.13 mg/dl. The difference between the two methods was 24.34 ± 12.01 mg/dl. A strong correlation (r = 0.805) was found between capillary and laboratory blood glucose levels, indicating a significant association (P < 0.0001). Twenty-two (44%) patients were in shock during the study. The mean difference between laboratory and POC blood glucose levels was higher in patients with circulatory shock (36.82 ± 4.84 mg/dl) than those without shock (14.61 ± 4.49 mg/dl), P < 0.05. Conclusion: POC glucose meters may lead to underdetection of hypoglycemia in critically ill patients, as their values are higher than laboratory values. Moreover, the results showed that POC glucometers are inaccurate for monitoring glucose in hypotensive patients in shock. Standard venous glucose monitoring methods may be more appropriate for these patients.

Ruptured Aortic Aneurysm in Pregnancy, Anesthetic Management of Endovascular Procedure.

ABSTRACT: Advanced pregnancy is associated with a higher risk of complicated aortopathies owing to the physiologic changes in pregnancy. The diagnosis can be elusive due to its rare incidence. The optimal treatment strategy is chosen based on the clinical condition of the patient, gestational age, and the severity of the aortic disease. A healthy young primigravida presented with acute chest pain in the early second trimester, diagnosed as a thoracic aortic aneurysm that had ruptured causing hemothorax. She underwent emergency endovascular repair under general anesthesia. Aortic disease should always be ruled out early in acute chest pain in pregnancy. Expeditious and strategic management helps improve maternal and fetal outcomes.

Comparison of percutaneous single-stage dilatational tracheostomy and surgical tracheostomy in critically ill patients: A randomized controlled trial.

Background: This study was done to compare single stage percutaneous dilation tracheostomy (PDT) and open surgical tracheostomy (ST) in critically ill patients. Methods: A randomized controlled study was conducted on 60 critically ill patients admitted in the intensive care unit (ICU). The patients were randomized into ST or PDT group with 30 in each group. The duration of procedure and associated perioperative/postoperative complications were noted and compared. Results: A total of 60 critically ill patients were included with 30 each in both groups. Compared to ST, PDT had significantly lesser mean duration of procedure (5 ± 1.64 vs. 21.33 ± 4.77 min, P < 0.0001) and comparable incidence of complications (3.33% vs. 20%, P = 0.103), which included 5-10 ml of bleeding (0% vs. 13.33%), cardiac arrest (0% vs. 3.33%), atrial fibrillation (3.33% vs. 0%), and tracheoesophageal fistula (0% vs. 3.33%). Conclusion: PDT performed in the ICU is a quick, safe, and reliable procedure with comparable complications to ST.