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!
New study: How does Europe become a leading player for software and IT services?
03.04.2017 | Fraunhofer-Institut für System- und Innovationsforschung (ISI)
Reusable carbon nanotubes could be the water filter of the future, says RIT study
30.03.2017 | Rochester Institute of Technology
More and more automobile companies are focusing on body parts made of carbon fiber reinforced plastics (CFRP). However, manufacturing and repair costs must be further reduced in order to make CFRP more economical in use. Together with the Volkswagen AG and five other partners in the project HolQueSt 3D, the Laser Zentrum Hannover e.V. (LZH) has developed laser processes for the automatic trimming, drilling and repair of three-dimensional components.
Automated manufacturing processes are the basis for ultimately establishing the series production of CFRP components. In the project HolQueSt 3D, the LZH has...
Reflecting the structure of composites found in nature and the ancient world, researchers at the University of Illinois at Urbana-Champaign have synthesized thin carbon nanotube (CNT) textiles that exhibit both high electrical conductivity and a level of toughness that is about fifty times higher than copper films, currently used in electronics.
"The structural robustness of thin metal films has significant importance for the reliable operation of smart skin and flexible electronics including...
The nearby, giant radio galaxy M87 hosts a supermassive black hole (BH) and is well-known for its bright jet dominating the spectrum over ten orders of magnitude in frequency. Due to its proximity, jet prominence, and the large black hole mass, M87 is the best laboratory for investigating the formation, acceleration, and collimation of relativistic jets. A research team led by Silke Britzen from the Max Planck Institute for Radio Astronomy in Bonn, Germany, has found strong indication for turbulent processes connecting the accretion disk and the jet of that galaxy providing insights into the longstanding problem of the origin of astrophysical jets.
Supermassive black holes form some of the most enigmatic phenomena in astrophysics. Their enormous energy output is supposed to be generated by the...
The probability to find a certain number of photons inside a laser pulse usually corresponds to a classical distribution of independent events, the so-called...
Microprocessors based on atomically thin materials hold the promise of the evolution of traditional processors as well as new applications in the field of flexible electronics. Now, a TU Wien research team led by Thomas Müller has made a breakthrough in this field as part of an ongoing research project.
Two-dimensional materials, or 2D materials for short, are extremely versatile, although – or often more precisely because – they are made up of just one or a...
28.04.2017 | Event News
20.04.2017 | Event News
18.04.2017 | Event News
28.04.2017 | Medical Engineering
28.04.2017 | Earth Sciences
28.04.2017 | Life Sciences