Intensive Insulin Therapy After Severe Traumatic Brain Injury: A Randomized Clinical Trial |
| |
Authors: | Federico Bilotta Remo Caramia Ibolja Cernak Francesca Paola Paoloni Andrea Doronzio Vincenzo Cuzzone Antonio Santoro Giovanni Rosa |
| |
Institution: | (1) Department of Anesthesiology, Critical Care and Pain Medicine, “La Sapienza” University of Rome, Viale Somalia 81, Rome, 00199, Italy;(2) The Johns Hopkins University Applied Physics Laboratory, Biomedicine Business Area, Laurel, MD, USA;(3) GIMEMA Data Center, Rome, Italy;(4) Department of Neurosurgery, “La Sapienza” University of Rome, Rome, Italy |
| |
Abstract: | Introduction To investigate the risks and possible benefits of routine versus intensive insulin therapy, assessed by the frequency of hypoglycemic
events defined as a glucose concentration less than 80 mg/dl (<4.44 mmol/l) in patients admitted to the intensive care unit
(ICU) after severe traumatic brain injury (TBI).
Methods and Results Ninety-seven patients admitted after severe TBI, were enrolled and randomly assigned to two groups of target glycemia. Insulin
was infused at conventional rates when blood glucose levels exceeded 220 mg/dl (12.22 mmol/l) or at intensive rates, to maintain
glycemia at 80–120 mg/dl (4.44–6.66 mmol/l). The following primary and outcome variables were measured during follow-up: hypoglycemic
episodes, duration of ICU stay, infection rate, and 6-month mortality and neurologic outcome measured using the Glasgow Outcome
Scale (GOS). Episodes of hypoglycemia (defined as blood glucose <80 mg/dl or 4.44 mmol/l) were significantly higher in patients
receiving intensive insulin therapy: median (min–max) conventional insulin therapy 7 (range 0–11) vs. intensive insulin therapy
15 (range 6–33); P<0.0001. Duration of ICU stay was shorter in patients receiving intensive insulin therapy (7.3 vs. 10.0 days; P < 0.05); while infection rates during ICU stay (25.0% vs. 38.8%, P = 0.15), and GOS scores and mortality at 6 months were similar in the two groups.
Conclusions Intensive insulin therapy significantly increases the risk of hypoglycemic episodes. Even though patients receiving intensive
insulin therapy have shorter ICU stays and infection rates similar to those receiving conventional insulin therapy, both groups
have similar follow-up mortality and neurologic outcome. Hence if intensive insulin therapy is to be used, great effort must
be taken to avoid hypoglycemia.
This work was done in the Department of Neuroanaesthesia, University of Rome “La Sapienza”, Rome, Italy, and was in part presented
at the Euroanaesthesia 2006 meeting Madrid, Spain. |
| |
Keywords: | Traumatic brain injury Intensive insulin infusion Hypoglycemia |
本文献已被 PubMed SpringerLink 等数据库收录! |
|