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Critical Care

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01.10.2008 | Commentary

Intensive glycemic control in traumatic brain injury: what is the ideal glucose range?

verfasst von: Paul M Vespa

Erschienen in: Critical Care | Ausgabe 5/2008

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Abstract

Intensive glycemic control has become standard practice. Existing data, however, suggest this practice may have adverse consequences for traumatic brain injury. The recent paper by Meier and colleagues suggests that intensive glycemic control may be deleterious. The present article explores existing literature surrounding this controversy, and outlines the literature that raises concern. Finally, I suggest an alternative course of action that may enable control of glucose in an optimal range.

Meier R, Béchir M, Ludwig S, Sommerfeld J, Keel M, Steiger P, Stocker R, Stover JF: Differential temporal profile of lowered blood glucose levels (3.5 to 6.5 mmol/l versus 5 to 8 mmol/l) in patients with severe traumatic brain injury. Crit Care 2008, 12: R98. 10.1186/cc6974PubMedCentralCrossRefPubMed

Lam AM, Winn HR, Cullen BF, Sundling N: Hyperglycemia and neurological outcome in patients with head injury. J Neurosurg 1991, 754: 545-551.CrossRef

Cochran A, Scaife ER, Hansen KW, Downey EC: Hyperglycemia and outcomes from pediatric traumatic brain injury. J Trauma 2003, 55: 1035-1038.CrossRefPubMed

De Salles AA, Muizelaar JP, Young HF: Hyperglycemia, cerebrospinal fluid lactic acidosis, and cerebral blood flow in severely headinjured patients. Neurosurgery 1987, 21: 45-50. 10.1097/00006123-198707000-00008CrossRefPubMed

Rovlias A, Kotsou S: The influence of hyperglycemia on neurological outcome in patients with severe head injury. Neurosurgery 2000, 46: 335-342. 10.1097/00006123-200002000-00015CrossRefPubMed

Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P, Bouillon R: Intensive insulin therapy in the critically ill patients. N Engl J Med 2001, 345: 1359-1367. 10.1056/NEJMoa011300CrossRefPubMed

Berghe G, Schoonheydt K, Becx P, Bruyninckx F, Wouters PJ: Insulin therapy protects the central and peripheral nervous system of intensive care patients. Neurology 2005, 64: 1348-1353.CrossRefPubMed

Berghe G, Wilmer A, Hermans G, Meersseman W, Wouters PJ, Milants I, Van Wijngaerden E, Bobbaers H, Bouillon R: Intensive insulin therapy in the medical ICU. N Engl J Med 2006, 354: 449-461. 10.1056/NEJMoa052521CrossRefPubMed

Vespa P, Boonyaputthikul P, McArthur DL, Miller C, Etchepare M, Bergsneider M, Glenn T, Martin NA, Hovda DA: Intensive insulin therapy reduces microdialysis glucose values without altering glucose utilization or improving the lactate/pyruvate ratio after traumatic brain injury. Crit Care Med 2006, 34: 850-856. 10.1097/01.CCM.0000201875.12245.6FCrossRefPubMed

10.

Schlenk F, Graetz D, Nagel A, Schmidt M, Sarrafzadeh AS: Insulin-related decrease in cerebral glucose despite normoglycemia in aneurysmal subarachnoid hemorrhage. Crit Care 2008, 12: R9. 10.1186/cc6776PubMedCentralCrossRefPubMed

11.

Zygun DA, Steiner LA, Johnston AJ, Hutchinson PJ, AlRawi PG, Chatfield D, Kirkpatrick PJ, Menon DK, Gupta AK: Hyperglycemia and brain tissue pH after traumatic brain injury. Neurosurgery 2004, 55: 877-881. 10.1227/01.NEU.0000137658.14906.E4CrossRefPubMed

12.

Bilotta F, Spinelli A, Giovannini F, Doronzio A, Delfini R, Rosa G: The effect of intensive insulin therapy on infection rate, vasospasm, neurologic outcome, and mortality in neurointensive care unit after intracranial aneurysm clipping in patients with acute subarachnoid hemorrhage: a randomized prospective pilot trial. J Neurosurg Anesthesiol 2007, 19: 156-160. 10.1097/ANA.0b013e3180338e69CrossRefPubMed

Titel: Intensive glycemic control in traumatic brain injury: what is the ideal glucose range?
verfasst von: Paul M Vespa
Publikationsdatum: 01.10.2008
Verlag: BioMed Central
Erschienen in: Critical Care / Ausgabe 5/2008
Elektronische ISSN: 1364-8535
DOI: https://doi.org/10.1186/cc6986

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