Increased Glucose Variability During Long-Term Therapeutic Hypothermia as a Predictor of Poor Neurological Outcomes and Mortality: A Retrospective Study

Oh, Tak Kyu; Heo, Eun-Jeong; Song, In-Ae; Jeong, Won Joo; Han, Moon‐Ku; Bang, Jae Seung

doi:10.1089/ther.2019.0004

Cited by 6 publications

(4 citation statements)

References 28 publications

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“…The duration of hypoglycaemia and hyperglycaemia has also been associated with worse neurodevelopmental outcomes at 12–24 months 8. Similarly in adult neurointensive care, increased glucose variability during long-term TH is a predictor of 90-day mortality and poor neurological outcomes 23. In cardiac intensive care studies hypothermia has been associated with higher blood glucose levels and increased glucose variability, the latter also being a predictor of in-hospital mortality independent of injury severity 24.…”

Section: Discussionmentioning

confidence: 99%

Continuous glucose monitoring during therapeutic hypothermia for hypoxic ischaemic encephalopathy: a feasibility study

Kalogeropoulou

Thomson

Beardsall

2022

Arch Dis Child Fetal Neonatal Ed

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ObjectivesGlucose dysregulation is common in infants with hypoxic ischaemic encephalopathy (HIE) and is likely to exacerbate cerebral injury. Infrequent measurement of glucose concentrations makes both identification and prevention of this risk challenging. Continuous glucose monitoring (CGM) has the potential to address both these challenges, but has not been explored in these infants. We aimed to evaluate the feasibility and potential impact of real-time CGM in term infants with HIE being treated with therapeutic hypothermia (TH).DesignFeasibility study.SettingTertiary-level neonatal unit, UK.PatientsTerm infants with HIE undergoing TH.InterventionA CGM sensor was inserted within 48 hours of birth and kept in situ for the first week of life. Clinical staff were blinded to the CGM recordings and clinical decisions were based on blood glucose assays.Main outcome measures(1) Accuracy of CGM values during and post TH, (2) Per cent of time spent outside the clinical range (2.6–10 mmol/L), (3) Episodes of hypoglycaemia and hyperglycaemia, (4) Adverse effects.ResultsThe accuracy of CGM values during TH were comparable to those when infants were normothermic. There was wide variation in per cent time outside the target range (2.6–10 mmol/L) between infants (median 5%, range 0%–34%). CGM identified 44% of infants with ≥1 episode of hypoglycaemia (<2.6 mmol/L) and 50% with ≥1 episode of hyperglycaemia (>10 mmol/L). No adverse events were observed.ConclusionsThis study demonstrates that CGM could be a useful adjunct for glucose monitoring in babies undergoing TH who are at risk of both hypoglycaemia and hyperglycaemia.

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Section: Discussionmentioning

confidence: 99%

Continuous glucose monitoring during therapeutic hypothermia for hypoxic ischaemic encephalopathy: a feasibility study

Kalogeropoulou

Thomson

Beardsall

2022

Arch Dis Child Fetal Neonatal Ed

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“…[22] Furthermore, various studies have shown that high blood glucose levels during TH are associated with poor neurological outcomes and increased mortality. [23,24] Besides, in the application of TH, rapid reaching target values in blood glucose level is associated with better neurological outcomes. [25] In a randomized clinical study, 136 patients were treated with TH and 137 patients with normothermia, and the results were compared.…”

Section: Discussionmentioning

confidence: 99%

The Use of Therapeutic Hypothermia in Patients Having Cardiac Arrest

Erkan¹

2022

GKDA Derg

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Objectives: Therapeutic hypothermia (TH) is applied to regain the quality of life in patients whose spontaneous blood circulation returns after cardiopulmonary resuscitation (CPR). In our study, we investigated the effects of TH after CPR. Methods: The findings of patients who underwent TH (Group 1, n=32) were compared with those of normothermic patients (Group 2, n=37) in this retrospective study. Recorded data were demographic data, comorbid diseases, causes of cardiac arrest, cardiac arrest rhythms, return times of spontaneous circulation, Glasgow coma scale, deep tendon reflex and brainstem reflex, extubation times, durations of intensive care unit (ICU) stay, and complications. Results: Extubation time in Group 1 (4.74±2.80 days) was shorter than in Group 2 (9.55±10.16 days). The length of stay in the ICU was shorter in Group 1 (7.96±5.10 days) compared to in Group 2 (13.40±11.40 days). Incidence of epileptic seizure activity was lower in Group 1 (16.2%) than in Group 2 (46.9%). Although Glasgow coma scale score evaluated at discharge was higher in Group 1, this difference was not statistically significant (p>0.05). Conclusion:We consider that the use of TH in patients whose spontaneous blood circulation was restored by CPR procedure after cardiac arrest has significant and positive effects on recovering the quality of life.

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“… [53] In patients with stroke and brain injury, high variation in blood glucose levels during long-term hypothermia therapy are predictors of poor nervous system outcomes and mortality. [54] Sepsis patients with blood glucose differences >65 mg/dL on the day of admission are at increased risk of 30-day mortality. This was observed among non-diabetic but not diabetic patients.…”

Section: Blood Glucose Monitoring In Critically Ill Patientsmentioning

confidence: 99%