Complicating the picture, poor glucose control also leads to worse recovery and should be avoided. This study suggests that a strategy to maintain intermediate glucose levels would contribute to better outcomes in these patients.
Hyperglycemia and hypoglycemia are common in critically ill patients and are strongly associated with worse outcomes. This is particularly important for neurologically ill patients, for whom poor glycemic control could contribute to secondary neurological damage. Hyperglycemia is known to be very harmful in such patients, potentially leading to further brain damage andincreased mortality.
On the other hand, hypoglycemia could cause neuroglycopenia – a shortage of glucose in the brain – which can lead to loss of consciousness, brain damage and, in some cases, even death. For these reasons, the same optimal glycemic targets for general critical care patients may not apply for neurologically injured patients.
Numerous randomized controlled trials (RCTs) have assessed the efficacy and safety of intensive insulin therapy and tight glycemic control regimens for critically ill patients, though these largely focus on mortality as the primary outcome, rather than functional recovery, which would be a more meaningful endpoint for neurological patients.
With the aim of determining better glycemic targets for neurologically injured patients, a research group from the Department of Critical Care Medicine at the University of Calgary, Canada, performed a systematic review and meta-analysis of RCTs comparing intensive insulin therapy to conventional glycemic control, among patients with neurological injuries, including traumatic brain injury, ischemic or hemorrhagic stroke, anoxic encephalopathy, central nervous system infection or spinal cord injury.
Sixteen RCTs, a combined total of 1,248 neurocritical care patients, were included. In the trials, glycemic control targets with intensive insulin ranged from 70-140 mg/dl, while conventional protocols aimed to keep glucose levels below 144-300 mg/dl.
Consistent with the results of recent large multicenter RCTs in non-neurological patients, the authors found that intensive glucose control did not reduce mortality among their neurocritical care patients, but it did reduce the occurrence of poor neurological outcomes. However, intensive insulin therapy significantly increases the risk of hypoglycemia. A benefit was not observed when intensive treatment was compared with more intermediate glycemic targets of 110-180mg/dl.
According to lead author Andreas Kramer, "Tight glucose control doesn't appear to improve mortality in neurocritical care patients." He continued, "Very loose glucose control is associated with worse neurological recovery and should be avoided. Our results support targeting more intermediate glycemic goals."
Media ContactDr Hilary Glover
Please name the journal in any story you write. If you are writing for the web, please link to the article. All articles are available free of charge, according to BioMed Central's open access policy.
Article citation and URL available on request on the day of publication.
2. Critical Care is a high quality, peer-reviewed, international clinical medical journal. Critical Care aims to improve the care of critically ill patients by acquiring, discussing, distributing, and promoting evidence-based information relevant to intensivists.
3. BioMed Central is an STM (Science, Technology and Medicine) publisher which has pioneered the open access publishing model. All peer-reviewed research articles published by BioMed Central are made immediately and freely accessible online, and are licensed to allow redistribution and reuse. BioMed Central is part of Springer Science+Business Media, a leading global publisher in the STM sector. @BioMedCentral
Hilary Glover | EurekAlert!
Do microplastics harbour additional risks by colonization with harmful bacteria?
05.04.2018 | Leibniz-Institut für Ostseeforschung Warnemünde
Rutgers-led innovation could spur faster, cheaper, nano-based manufacturing
14.02.2018 | Rutgers University
Novel highly efficient and brilliant gamma-ray source: Based on model calculations, physicists of the Max PIanck Institute for Nuclear Physics in Heidelberg propose a novel method for an efficient high-brilliance gamma-ray source. A giant collimated gamma-ray pulse is generated from the interaction of a dense ultra-relativistic electron beam with a thin solid conductor. Energetic gamma-rays are copiously produced as the electron beam splits into filaments while propagating across the conductor. The resulting gamma-ray energy and flux enable novel experiments in nuclear and fundamental physics.
The typical wavelength of light interacting with an object of the microcosm scales with the size of this object. For atoms, this ranges from visible light to...
Stable joint cartilage can be produced from adult stem cells originating from bone marrow. This is made possible by inducing specific molecular processes occurring during embryonic cartilage formation, as researchers from the University and University Hospital of Basel report in the scientific journal PNAS.
Certain mesenchymal stem/stromal cells from the bone marrow of adults are considered extremely promising for skeletal tissue regeneration. These adult stem...
In the fight against cancer, scientists are developing new drugs to hit tumor cells at so far unused weak points. Such a “sore spot” is the protein complex...
In an article that appears in the journal “Review of Modern Physics”, researchers at the Laboratory for Attosecond Physics (LAP) assess the current state of the field of ultrafast physics and consider its implications for future technologies.
Physicists can now control light in both time and space with hitherto unimagined precision. This is particularly true for the ability to generate ultrashort...
The Atlantic overturning – one of Earth’s most important heat transport systems, pumping warm water northwards and cold water southwards – is weaker today than any time before in more than 1000 years. Sea surface temperature data analysis provides new evidence that this major ocean circulation has slowed down by roughly 15 percent since the middle of the 20th century, according to a study published in the highly renowned journal Nature by an international team of scientists. Human-made climate change is a prime suspect for these worrying observations.
“We detected a specific pattern of ocean cooling south of Greenland and unusual warming off the US coast – which is highly characteristic for a slowdown of the...
13.04.2018 | Event News
12.04.2018 | Event News
09.04.2018 | Event News
19.04.2018 | Power and Electrical Engineering
19.04.2018 | Life Sciences
18.04.2018 | Materials Sciences