Impact of tight glycemic control on cerebral glucose metabolism after severe brain injury: a microdialysis study.

Détails

ID Serval
serval:BIB_BC1B754A9742
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Impact of tight glycemic control on cerebral glucose metabolism after severe brain injury: a microdialysis study.
Périodique
Critical Care Medicine
Auteur(s)
Oddo M., Schmidt J.M., Carrera E., Badjatia N., Connolly E.S., Presciutti M., Ostapkovich N.D., Levine J.M., Le Roux P., Mayer S.A.
ISSN
1530-0293[electronic]
Statut éditorial
Publié
Date de publication
2008
Volume
36
Numéro
12
Pages
3233-3238
Langue
anglais
Résumé
OBJECTIVES: To analyze the effect of tight glycemic control with the use of intensive insulin therapy on cerebral glucose metabolism in patients with severe brain injury. DESIGN: Retrospective analysis of a prospective observational cohort. SETTING: University hospital neurologic intensive care unit. PATIENTS: Twenty patients (median age 59 yrs) monitored with cerebral microdialysis as part of their clinical care. INTERVENTIONS: Intensive insulin therapy (systemic glucose target: 4.4-6.7 mmol/L [80-120 mg/dL]). MEASUREMENTS AND MAIN RESULTS: Brain tissue markers of glucose metabolism (cerebral microdialysis glucose and lactate/pyruvate ratio) and systemic glucose were collected hourly. Systemic glucose levels were categorized as within the target "tight" (4.4-6.7 mmol/L [80-120 mg/dL]) vs. "intermediate" (6.8-10.0 mmol/L [121-180 mg/dL]) range. Brain energy crisis was defined as a cerebral microdialysis glucose <0.7 mmol/L with a lactate/pyruvate ratio >40. We analyzed 2131 cerebral microdialysis samples: tight systemic glucose levels were associated with a greater prevalence of low cerebral microdialysis glucose (65% vs. 36%, p < 0.01) and brain energy crisis (25% vs.17%, p < 0.01) than intermediate levels. Using multivariable analysis, and adjusting for intracranial pressure and cerebral perfusion pressure, systemic glucose concentration (adjusted odds ratio 1.23, 95% confidence interval [CI] 1.10-1.37, for each 1 mmol/L decrease, p < 0.001) and insulin dose (adjusted odds ratio 1.10, 95% CI 1.04-1.17, for each 1 U/hr increase, p = 0.02) independently predicted brain energy crisis. Cerebral microdialysis glucose was lower in nonsurvivors than in survivors (0.46 +/- 0.23 vs. 1.04 +/- 0.56 mmol/L, p < 0.05). Brain energy crisis was associated with increased mortality at hospital discharge (adjusted odds ratio 7.36, 95% CI 1.37-39.51, p = 0.02). CONCLUSIONS: In patients with severe brain injury, tight systemic glucose control is associated with reduced cerebral extracellular glucose availability and increased prevalence of brain energy crisis, which in turn correlates with increased mortality. Intensive insulin therapy may impair cerebral glucose metabolism after severe brain injury.
Mots-clé
Adult, Aged, Blood Glucose/analysis, Brain/metabolism, Brain/physiopathology, Brain Injuries/metabolism, Brain Injuries/physiopathology, Female, Glucose/metabolism, Hospitals, University, Humans, Hypoglycemic Agents/therapeutic use, Insulin/therapeutic use, Intensive Care Units, Intracranial Pressure, Lactic Acid/analysis, Male, Microdialysis, Middle Aged, Pyruvic Acid/analysis, Retrospective Studies
Pubmed
Web of science
Création de la notice
12/10/2009 15:25
Dernière modification de la notice
20/08/2019 16:30
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