Intensive insulin therapy on infection rate, days in NICU, in-hospital mortality and neurological outcome in severe traumatic brain injury patients: A randomized controlled trial

Yang, Meng; Guo, Qi; Zhang, Xiangtong; Sun, Shugang; Wang, Yaohua; Zhao, Lu; Hu, Enxi; Li, Changyu

doi:10.1016/j.ijnurstu.2009.01.004

Cited by 67 publications

(46 citation statements)

References 22 publications

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“…Clinical neuroprotective effects included reduction of intracranial pressure, reduction of seizures, and better long-term rehabilitation in patients with isolated brain injury, together with a lower incidence of critical illness-induced neuromyopathy. Subsequent randomized controlled studies in critically ill patients with acute brain injury [57][58][59][60][61][62][63] or with acute ischemic stroke [64][65][66] showed mostly no benefit in terms of neurological outcomes (Table 2). A recent systematic review on acute ischemic stroke concluded that intravenous insulin administration aiming to maintain serum glucose within a specific range did not improve the neurological deficit [67].…”

Section: Is Blood Glucose Control With Insulin During Critical Illnesmentioning

confidence: 99%

Critical illness-induced dysglycemia and the brain

et al. 2014

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Section: Is Blood Glucose Control With Insulin During Critical Illnesmentioning

confidence: 99%

Critical illness-induced dysglycemia and the brain

et al. 2014

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“…On the other hand, randomized controlled trials focusing on severely brain-injured patients, such as those with traumatic brain injury (TBI) or intra-cerebral hemorrhage (ICH), are scarce. Clinical studies are monocentric [5], frequently retrospective [6] and performed in small cohorts of patients [7]. Large randomized controlled trials did not evaluate specifically the impact of tight glucose control on neurological outcome in this specific ICU population [2].…”

Section: Introductionmentioning

confidence: 99%

Effects of tight computerized glucose control on neurological outcome in severely brain injured patients: a multicenter sub-group analysis of the randomized-controlled open-label CGAO-REA study

et al. 2014

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IntroductionHyperglycemia is a marker of poor prognosis in severe brain injuries. There is currently little data regarding the effects of intensive insulin therapy (IIT) on neurological recovery.MethodsA sub-group analysis of the randomized-controlled CGAO-REA study (NCT01002482) in surgical intensive care units (ICU) of two university hospitals. Patients with severe brain injury, with an expected ICU length of stay ≥48 hours were included. Patients were randomized between a conventional glucose management group (blood glucose target between 5.5 and 9 mmol.L−1) and an IIT group (blood glucose target between 4.4 and 6 mmol.L−1). The primary outcome was the day-90 neurological outcome evaluated with the Glasgow outcome scale.ResultsA total of 188 patients were included in this analysis. In total 98 (52%) patients were randomized in the control group and 90 (48%) in the IIT group. The mean Glasgow coma score at baseline was 7 (±4). Patients in the IIT group received more insulin (130 (68 to 251) IU versus 74 (13 to 165) IU in the control group, P = 0.01), had a significantly lower morning blood glucose level (5.9 (5.1 to 6.7) mmol.L−1 versus 6.5 (5.6 to 7.2) mmol.L−1, P <0.001) in the first 5 days after ICU admission. The IIT group experienced more episodes of hypoglycemia (P <0.0001). In the IIT group 24 (26.6%) patients had a favorable neurological outcome (good recovery or moderate disability) compared to 31 (31.6%) in the control group (P = 0.4). There were no differences in day-28 mortality. The occurrence of hypoglycemia did not influence the outcome.ConclusionsIn this sub-group analysis of a large multicenter randomized trial, IIT did not appear to alter the day-90 neurological outcome or ICU morbidity in severe brain injured patients or ICU morbidity.

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“…[3,43] Randomized controlled trials examining high dose insulin therapy showed no improvement of neurological disability or mortality, but a large number of hypoglycemic events. [52,53] …”

Section: Glucocorticoids and Insulin Therapymentioning

confidence: 99%

“…[58][59][60] The use of hypothermia remains controversial and is not currently supported by multiple meta-analysis showing potential harm. [52,53] However, hypothermia has been used as salvage therapy for patients with persistently elevated ICPs resistant to all other treatments.…”

Section: Therapeutic Hypothermiamentioning

confidence: 99%

Traumatic brain injury: A case-based review

Escobedo¹,

Habboushe²,

Kaafarani³

et al. 2013

World Journal of Emergency Medicine

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BACKGROUND: Traumatic brain injuries are common and costly to hospital systems. Most of the guidelines on management of traumatic brain injuries are taken from the Brain Trauma Foundation Guidelines. This is a review of the current literature discussing the evolving practice of traumatic brain injury.DATA SOURCES: A literature search using multiple databases was performed for articles published through September 2012 with concentration on meta-analyses, systematic reviews, and randomized controlled trials. RESULTS:The focus of care should be to minimize secondary brain injury by surgically decompressing certain hematomas, maintain systolic blood pressure above 90 mmHg, oxygen saturations above 93%, euthermia, intracranial pressures below 20 mmHg, and cerebral perfusion pressure between 60-80 mmHg. CONCLUSION:Much is still unknown about the management of traumatic brain injury. The current practice guidelines have not yet been sufficiently validated, however equipoise is a major issue when conducting randomized control trials among patients with traumatic brain injury.

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Intensive insulin therapy on infection rate, days in NICU, in-hospital mortality and neurological outcome in severe traumatic brain injury patients: A randomized controlled trial

Cited by 67 publications

References 22 publications

Critical illness-induced dysglycemia and the brain

Critical illness-induced dysglycemia and the brain

Effects of tight computerized glucose control on neurological outcome in severely brain injured patients: a multicenter sub-group analysis of the randomized-controlled open-label CGAO-REA study

Traumatic brain injury: A case-based review

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