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!
Researchers simplify tiny structures' construction drip by drip
12.11.2018 | Princeton University, Engineering School
Mandibular movement monitoring may help improve oral sleep apnea devices
06.11.2018 | Elsevier
Biochips have been developed at TU Wien (Vienna), on which tissue can be produced and examined. This allows supplying the tissue with different substances in a very controlled way.
Cultivating human cells in the Petri dish is not a big challenge today. Producing artificial tissue, however, permeated by fine blood vessels, is a much more...
Faster and secure data communication: This is the goal of a new joint project involving physicists from the University of Würzburg. The German Federal Ministry of Education and Research funds the project with 14.8 million euro.
In our digital world data security and secure communication are becoming more and more important. Quantum communication is a promising approach to achieve...
On Saturday, 10 November 2018, the research icebreaker Polarstern will leave its homeport of Bremerhaven, bound for Cape Town, South Africa.
When choosing materials to make something, trade-offs need to be made between a host of properties, such as thickness, stiffness and weight. Depending on the application in question, finding just the right balance is the difference between success and failure
Now, a team of Penn Engineers has demonstrated a new material they call "nanocardboard," an ultrathin equivalent of corrugated paper cardboard. A square...
Physicists at ETH Zurich demonstrate how errors that occur during the manipulation of quantum system can be monitored and corrected on the fly
The field of quantum computation has seen tremendous progress in recent years. Bit by bit, quantum devices start to challenge conventional computers, at least...
09.11.2018 | Event News
06.11.2018 | Event News
23.10.2018 | Event News
13.11.2018 | Life Sciences
13.11.2018 | Life Sciences
13.11.2018 | Awards Funding