In 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. The occurrence of hypoglycemia did not influence the outcome. There were no differences in day-28 mortality. 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). The IIT group experienced more episodes of hypoglycemia ( P <0.0001).
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 mean Glasgow coma score at baseline was 7 (±4). In total 98 (52%) patients were randomized in the control group and 90 (48%) in the IIT group. ResultsĪ total of 188 patients were included in this analysis. The primary outcome was the day-90 neurological outcome evaluated with the Glasgow outcome scale. 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). Patients with severe brain injury, with an expected ICU length of stay ≥48 hours were included.
MethodsĪ sub-group analysis of the randomized-controlled CGAO-REA study (NCT01002482) in surgical intensive care units (ICU) of two university hospitals. There is currently little data regarding the effects of intensive insulin therapy (IIT) on neurological recovery. Hyperglycemia is a marker of poor prognosis in severe brain injuries.
0 kommentar(er)
