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Critical Care
Published in: Critical Care 5/2008

01-10-2008 | Commentary

Intensive glycemic control in traumatic brain injury: what is the ideal glucose range?

Author: Paul M Vespa

Published in: Critical Care | Issue 5/2008

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Abstract

Intensive glycemic control has become standard practice. Existing data, however, suggest this practice may have adverse consequences for traumatic brain injury. The recent paper by Meier and colleagues suggests that intensive glycemic control may be deleterious. The present article explores existing literature surrounding this controversy, and outlines the literature that raises concern. Finally, I suggest an alternative course of action that may enable control of glucose in an optimal range.
Literature
1.
Meier R, Béchir M, Ludwig S, Sommerfeld J, Keel M, Steiger P, Stocker R, Stover JF: Differential temporal profile of lowered blood glucose levels (3.5 to 6.5 mmol/l versus 5 to 8 mmol/l) in patients with severe traumatic brain injury. Crit Care 2008, 12: R98. 10.1186/cc6974PubMedCentralCrossRefPubMed
2.
Lam AM, Winn HR, Cullen BF, Sundling N: Hyperglycemia and neurological outcome in patients with head injury. J Neurosurg 1991, 754: 545-551.CrossRef
3.
Cochran A, Scaife ER, Hansen KW, Downey EC: Hyperglycemia and outcomes from pediatric traumatic brain injury. J Trauma 2003, 55: 1035-1038.CrossRefPubMed
4.
De Salles AA, Muizelaar JP, Young HF: Hyperglycemia, cerebrospinal fluid lactic acidosis, and cerebral blood flow in severely headinjured patients. Neurosurgery 1987, 21: 45-50. 10.1097/00006123-198707000-00008CrossRefPubMed
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Rovlias A, Kotsou S: The influence of hyperglycemia on neurological outcome in patients with severe head injury. Neurosurgery 2000, 46: 335-342. 10.1097/00006123-200002000-00015CrossRefPubMed
6.
Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P, Bouillon R: Intensive insulin therapy in the critically ill patients. N Engl J Med 2001, 345: 1359-1367. 10.1056/NEJMoa011300CrossRefPubMed
7.
Berghe G, Schoonheydt K, Becx P, Bruyninckx F, Wouters PJ: Insulin therapy protects the central and peripheral nervous system of intensive care patients. Neurology 2005, 64: 1348-1353.CrossRefPubMed
8.
Berghe G, Wilmer A, Hermans G, Meersseman W, Wouters PJ, Milants I, Van Wijngaerden E, Bobbaers H, Bouillon R: Intensive insulin therapy in the medical ICU. N Engl J Med 2006, 354: 449-461. 10.1056/NEJMoa052521CrossRefPubMed
9.
Vespa P, Boonyaputthikul P, McArthur DL, Miller C, Etchepare M, Bergsneider M, Glenn T, Martin NA, Hovda DA: Intensive insulin therapy reduces microdialysis glucose values without altering glucose utilization or improving the lactate/pyruvate ratio after traumatic brain injury. Crit Care Med 2006, 34: 850-856. 10.1097/01.CCM.0000201875.12245.6FCrossRefPubMed
10.
Schlenk F, Graetz D, Nagel A, Schmidt M, Sarrafzadeh AS: Insulin-related decrease in cerebral glucose despite normoglycemia in aneurysmal subarachnoid hemorrhage. Crit Care 2008, 12: R9. 10.1186/cc6776PubMedCentralCrossRefPubMed
11.
Zygun DA, Steiner LA, Johnston AJ, Hutchinson PJ, AlRawi PG, Chatfield D, Kirkpatrick PJ, Menon DK, Gupta AK: Hyperglycemia and brain tissue pH after traumatic brain injury. Neurosurgery 2004, 55: 877-881. 10.1227/01.NEU.0000137658.14906.E4CrossRefPubMed
12.
Bilotta F, Spinelli A, Giovannini F, Doronzio A, Delfini R, Rosa G: The effect of intensive insulin therapy on infection rate, vasospasm, neurologic outcome, and mortality in neurointensive care unit after intracranial aneurysm clipping in patients with acute subarachnoid hemorrhage: a randomized prospective pilot trial. J Neurosurg Anesthesiol 2007, 19: 156-160. 10.1097/ANA.0b013e3180338e69CrossRefPubMed
Metadata
Title
Intensive glycemic control in traumatic brain injury: what is the ideal glucose range?
Author
Paul M Vespa
Publication date
01-10-2008
Publisher
BioMed Central
Published in
Critical Care / Issue 5/2008
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc6986

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