Point-of-Care-Testing (POCT) in intensive care medicine

After successful centralization of laboratory analyses since more than 30 y ears, advances in biosensors, microprocessors, measurement of undiluted who le blood and miniaturization of laboratory analyzers are leading nowadays m ore and more to a re-decentralization in the laboratory medicine. Point-of- care-testing (POCT), which is defined as any laboratory test performed outs ide central or decentralized laboratories, is becoming more and more popula r. The theoretical advantages of POCT are faster turn-around-times (TAT), m ore rapid medical decisions,avoidance of sample identification and sample t ransport problems and the need of only small specimen volumes. These advant ages are frequently mentioned, but are not associated with a clear clinical benefit. The disadvantages of POCT such as incorrect handling and/or maint enance of the analyzers by nontrained clinical staff inadequate or even abs ent calibrations and/or quality controls, lack of cost-effectiveness becaus e of an increased number of analyzers and more expensive reagents, insuffic ient documentation and difficult comparability of the obtained POCT results with routine laboratory results, are strongly evident. According to the au thors' opinion the decision for the establishing of POCT has only to be mad e in a close co-operation between physicians and laboratorians in order to vouch for necessity and high quality of the analyses. Taking the local situ ation into consideration (24-h-central laboratory, etc.) the spectrum of pa rameters measured by means of POCT should be rigorously restricted to the v ital functions. Such analytes should be: hemoglobin or hematocrit, activate d whole blood clotting time, blood gases, sodium, potassium, ionized calciu m, glucose, creatinine, ammonia and lactate.