(1424813-01) Continuous Glucose Monitors and Artificial Pancreas Devices in the ICU

Glucose monitoring in the critically ill is fraught with difficulty.  On one hand, point-of-care glucose meters offer rapid results of particular concern in patients withcritical glucose values.  Unfortunately, these devices are prone to problems with accuracy, interferences and pre-analytic error related to sample site glucose concentration aberrancies in the critically ill.  While newer devices improve on these weaknesses there is also a push towards continuous and near-continuous measurement of glucose in order to minimize glycemic variability and time spent outside of target glucose ranges.  These continuous glucose meters (CGMs) carry their own sampling considerations, interference and sources of error, but they can be integrated with insulin pumps and computer-driven therapeutic algorithms in an artificial pancreas device (APD) setup to dictate ultra-short insulin infusions in real-time aiming for  glucose goals. APDs are now in broad use in the outpatient arena, but more intensive vascular sampling and delivering also exist.  The use of CGMs and APDs in the critically ill will be reviewed including a discussion of their strengths and current limitations.