Glycemia Management in Neurocritical Care Patients

Bilotta, Federico; Giovannini, F.; Caramia, Remo; Rosa, Giovanni

doi:10.1097/ana.0b013e31818f8a5c

Cited by 40 publications

(33 citation statements)

References 81 publications

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“…Patients with severe hyperglycemia did not have more severe clinical presentation on admission, but the mechanism associated with worsened outcome in patients with hyperglycemia was found to be unrelated to exaggerated inflammation, coagulation or endothelial cell activation, in contrast with other previous findings (12)(13)(14).…”

Section: Admission Hyperglycemia and Outcome In Icu Patients With Sepsiscontrasting

confidence: 84%

Admission hyperglycemia and outcome in ICU patients with sepsis

Robba

Bilotta

2016

J. Thorac. Dis.

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Section: Admission Hyperglycemia and Outcome In Icu Patients With Sepsiscontrasting

confidence: 84%

Admission hyperglycemia and outcome in ICU patients with sepsis

Robba

Bilotta

2016

J. Thorac. Dis.

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“…1,5 Acute hyperglycemia also seems to have adverse effects on the CNS through an increased production of lactic acid and free radicals in the glial tissue, increased release of excitatory amino acids, increased intracellular calcium level, and mitochondrial and endothelial dysfunction. 4 Although biologically plausible, in testing the hy- pothesis that hyperglycemia is a causative agent of greater postoperative morbidity, our study, similar to the majority of published studies on the topic, faces the inherent limitations of a retrospective study that does not adequately control for the necessary variables to determine causality between these 2 events.…”

Section: Discussionmentioning

confidence: 99%

Association of increased morbidity with the occurrence of hyperglycemia in the immediate postoperative period after elective pediatric neurosurgery

Filho¹,

Alves²,

Fernandes³

et al. 2016

PED

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OBJECTIVE The acute elevation of blood glucose in perioperative pediatric patients subjected to cardiac surgery and in victims of head trauma is associated with higher rates of postoperative complications. Data on the occurrence of hyperglycemia and its association with unfavorable outcomes among patients who have undergone elective neurosurgery are scarce in the literature. This study aimed to determine whether the occurrence of hyperglycemia during the perioperative period of elective neurosurgery for the resection of tumors of the CNS in children is associated with increased morbidity. METHODS This retrospective cohort analysis included 105 children up to 12 years of age who underwent elective neurosurgery for resection of supratentorial and infratentorial CNS tumors between January 2005 and December 2010 at the São Rafael Hospital, a tertiary care medical center in Salvador, Brazil. Demographic data and intraoperative and postoperative information were collected from the medical records. Differences in blood glucose levels during the perioperative period were evaluated with nonparametric tests. RESULTS The patients who developed postoperative complications exhibited higher blood glucose levels on admission to the intensive care unit (ICU) (162.0 ± 35.8 mg/dl vs 146.3 ± 43.3 mg/dl; p = 0.016) and peak blood glucose levels on postoperative Day 1 (171.9 ± 30.2 mg/dl vs 156.1 ± 43.2 mg/dl; p = 0.008). Multivariate analysis showed that peak blood glucose levels on postoperative Day 1 were independently associated with a higher odds ratio for postoperative complication (OR 1.05). The occurrence of hyperglycemia (>150 mg/dl) upon admission to the ICU was associated with longer ICU (p = 0.003) and hospital (p = 0.001) stays. CONCLUSIONS The occurrence of hyperglycemia during the postoperative period after elective pediatric neurosurgery for the resection of CNS tumors was associated with longer hospital and ICU stays. Postoperative complications were associated with higher blood glucose levels upon admission to the ICU and higher peak blood glucose on the first postoperative day.

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“…Moreover, ghrelin has been reported to impact insulin secretion and glucose metabolism (49,50). Patients with brain injury are particularly vulnerable to high blood glucose concentrations (51,52). Both hypo-and hyperglycemia affect prognosis in braininjured patients, and there is an increasing belief that strict glucose control may benefit these patients (53).…”

Section: Discussionmentioning

confidence: 99%

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et al. 2012

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Traumatic brain injury (TBI) and hemorrhagic shock often occur concomitantly due to multiple injuries. Gastrointestinal dysfunction occurs frequently in patients with TBI. However, whether alterations in the gastrointestinal system are involved in modulating neuronal damage and recovery after TBI is largely neglected. Ghrelin is a "gut-brain" hormone with multiple functions including antiinflammation and antiapoptosis. The purpose of this study was to determine whether ghrelin attenuates brain injury in a rat model of TBI and uncontrolled hemorrhage (UH). To study this, brain injury was induced by dropping a 450-g weight from 1.5 m onto a steel helmet attached to the skull of male adult rats. Immediately after TBI, a midline laparotomy was performed and both lumbar veins were isolated and severed at the junction with the vena cava. At 45 min after TBI/UH, ghrelin (4, 8 or 16 nmol/rat) or 1 mL normal saline (vehicle) was intravenously administered. Brain levels of TNF-α and IL-6, and cleaved PARP-1 levels in the cortex were measured at 4 h after TBI/UH. Beam balance test, forelimb placing test and hindlimb placing test were used to assess sensorimotor and reflex function. In additional groups of animals, ghrelin (16 nmol/rat) or vehicle was subcutaneously (s.c.) administered daily for 10 d after TBI/UH. The animals were monitored for 28 d to record body weight changes, neurological severity scale and survival. Our results showed that ghrelin downregulated brain levels of TNF-α and IL-6, reduced cortical levels of cleaved PARP-1, improved sensorimotor and reflex functions, and decreased mortality after TBI/UH. Thus, ghrelin has a great potential to be further developed as an effective resuscitation approach for the trauma victims with brain injury and severe blood loss.

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Glycemia Management in Neurocritical Care Patients

Cited by 40 publications

References 81 publications

Admission hyperglycemia and outcome in ICU patients with sepsis

Admission hyperglycemia and outcome in ICU patients with sepsis

Association of increased morbidity with the occurrence of hyperglycemia in the immediate postoperative period after elective pediatric neurosurgery

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