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Blood Glucose Control Among Critically Ill Patients with Brain Injury

Published online by Cambridge University Press:  02 December 2014

Michael J. Jacka
Affiliation:
Department of Anaesthesiology and Pain Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
Clinton J. Torok-Both
Affiliation:
Department of Anaesthesiology and Pain Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
Sean M. Bagshaw*
Affiliation:
Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
*
Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 3C1.12 Walter C. Mackenzie Centre, 8440-112 Street, Edmonton, Alberta, T6G 2B7, Canada
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Abstract

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Objective:

To evaluate the incidence of hypoglycemia, hyperglycemia and blood glucose (BG) variability in brain-injured patients and their association with clinical outcomes.

Methods:

Retrospective cohort study of brain-injured patients admitted to an 11- bed neurosciences intensive care unit (ICU) from January 1 to December 31, 2003.

Results:

We included 606 patients. Mean age was 52.3 years, 60.6% were male, 11.9% had diabetes mellitus, and 64% were post-operative. Seventy-five (12.4%) received intensive insulin therapy (IIT) for a median (IQR) 72 (24-154) hours. Hypoglycemia and hyperglycemia occurred in 4.6% (96.4% receiving IIT) and 9.6% (77.6% receiving IIT). Median number of episodes per patient was 3 (75% with ≥2) and 4 (81% with ≥2) for hypoglycemia and hyperglycemia. Variable glycemic control occurred in 3.8% (100% receiving IIT) with median number of 13 episodes per patient. In-hospital mortality was 16.7%, median (IQR) ICU and hospital lengths of stay were 2 (1-5) and 8 (3-19) days. Hypoglycemia, hyperglycemia and BG variability showed non-significant but consistent associations with hospital mortality and prolonged lengths of ICU and hospital stay. The rate of recurrence of episodes showed stronger and significant associations with outcome, in particular for BG variability and hyperglycemia.

Conclusions:

Hypoglycemia, hyperglycemia and BG variability are relatively common in brain-injured patients and are associated with IIT. An increased frequency of episodes, in particular for BG variability and hyperglycemia, was associated with greater risk of both hospital death and prolonged duration of stay.

Résumé:

RÉSUMÉ:Objectif :

Le but de l’étude était d’évaluer l’incidence de l’hypoglycémie, de l’hyperglycémie et de la variabilité du glucose sanguin (GS) chez les patients atteints d’un traumatisme cérébral ainsi que la relation à l’issue clinique.

Méthodes :

Il s’agit d’une étude rétrospective sur une cohorte de patients atteints d’un traumatisme cérébral admis à une unité de soins intensifs neurologiques (USI) de 11 lits entre le 1er janvier et le 31 décembre 2003.

Résultats :

Six cent six patients, dont l’âge moyen était de 52,3 ans, ont été inclus dans l’étude. De plus, 60,6% étaient des hommes, 11,9% étaient diabétiques et 64% avaient subi une chirurgie. Soixante-quinze patients (12,4%) ont reçu une insulinothérapie intensive (ITI) dont la durée médiane était de 72 heures (écart interquartile de 24 à 154 heures). De l’hypoglycémie a été observée chez 4,6% (96,4% recevaient une ITI) et de l’hyperglycémie chez 9,6% (77,6% recevaient une ITI). Le nombre médian d’épisodes d’hypoglycémie par patient était de 3 (75% ont eu ≥ 2 épisodes) et le nombre median d’épisodes d’hyperglycémie par patient était de 4 (81% ont eu ≥ 2 épisodes). Une maîtrise variable du GS a été observée chez 3,8% (100% sous ITI) et le nombre médian d’épisodes par patient était de 13. La mortalité hospitalière était de 16,7%, la durée de séjour médiane à l’USI de 2 jours (écart interquartile de 1 à 5 jours) et la durée d’hospitalisation de 8 jours (écart interquartile de 3 à 19 jours). L’hypoglycémie, l’hyperglycémie et la variabilité du GS étaient associées de façon constante mais non significative à la mortalité hospitalière et à une durée prolongée du séjour à l’USI et du séjour à l’hôpital. L’association entre le taux de récidive des épisodes et l’issue était plus marquée et significative, particulièrement en ce qui concerne la variabilité du GS et l’hyperglycémie.

Conclusions :

L’hypoglycémie, l’hyperglycémie et la variabilité du GS sont relativement fréquentes chez les patients atteints d’un traumatisme cerebral et sont associées à l’ITI. Une fréquence accrue d’épisodes, en ce qui concerne surtout la variabilité du GS et l’hyperglycémie, était associée à un risqué plus élevé de mortalité hospitalière et d’un séjour hospitalier prolongé.

Type
Original Article
Copyright
Copyright © The Canadian Journal of Neurological 2009

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