The Impact of Hyperglycemia on Patients With Severe Brain Injury

Jeremitsky, Élan; Omert, Laurel; Dunham, C. Michael; Wilberger, Jack E.; Rodríguez, Aurelio

doi:10.1097/01.ta.0000135158.42242.b1

Cited by 320 publications

(130 citation statements)

References 18 publications

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“…The explanation would be that these patients have a more important metabolic response to injury due to the effects of cortisol, glucagon and epinephrine release, causing intrac-pediatric head trauma: hyperglycemia Melo et al ellular acidosis, lactate accumulation, high blood glucose levels and neuronal injury 6,[19][20][21] . Therefore, our data are in accordance with the results from other authors who correlate the head trauma severity and the metabolic response to trauma, particularly higher blood glucose levels 7,22,23 . Some studies show that hyperglycemia is associated with a worse outcome, regardless of injury characteristics 24 .…”

Section: Discussionsupporting

confidence: 83%

Hyperglycemia in pediatric head trauma patients: a cross-sectional study

Melo

Reis²,

Lemos-Júnior³

et al. 2009

Arq. Neuro-Psiquiatr.

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-Objective: To verify the prevalence of acute hyperglycemia in children with head trauma stratified by the Glasgow coma scale (GCS). Method: A prospective cross-sectional study carried out with information from medical records of pediatric patients presenting with head injury in the emergency room of a referral emergency hospital during a one year period. We considered the cut-off value of 150 mg/dL to define hyperglycemia. Results: A total of 340 children were included and 60 (17.6%) had admission hyperglycemia. Hyperglycemia was present in 9% of mild head trauma cases; 30.4% of those with moderate head trauma and 49% of severe head trauma. We observed that among children with higher blood glucose levels, 85% had abnormal findings on cranial computed tomography scans. Conclusion: Hyperglycemia was more prevalent in patients with severe head trauma (GCS ≤8), regardless if they had or not multiple traumas and in children with abnormal findings on head computed tomography scans.Key WordS: adolescents, children, head trauma, hyperglycemia, prevalence. Hiperglicemia em pacientes pediátricos com traumatismo craniencefálico: estudo de corte transversalResumo -Objetivo: Verificar a prevalência de hiperglicemia aguda em crianças vítimas de trauma craniencefálico, de acordo com a escala de coma de Glasgow (GCS). Método: estudo prospectivo, de corte transversal realizado por meio do acompanhamento de prontuários médicos de pacientes na faixa etária pediátrica admitidos na unidade de urgência de um hospital de referência vítimas de traumatismo craniencefálico, durante um ano. Consideramos o valor de corte em 150 mg/dL para definição de hiperglicemia. Resultados: 340 crianças foram incluídas no estudo e 60 (17,6%) apresentaram hiperglicemia na admissão. Hiperglicemia esteve presente em 9% dos casos de trauma craniano leve, 30,4% daqueles com trauma craniano moderado e em 49% dos pacientes com trauma craniano grave. Verificamos que, entre as crianças com níveis elevados de glicemia, 85% apresentavam alterações radiológicas verificadas na tomografia computadorizada do crânio. Conclusão: A hiperglicemia foi mais prevalente em pacientes com traumatismo craniano grave (GCS ≤8), assim como naqueles com alterações identificadas na tomografia computadorizada do crânio, independente da presença de politraumatismo.

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Section: Discussionsupporting

confidence: 83%

Hyperglycemia in pediatric head trauma patients: a cross-sectional study

Melo

Reis²,

Lemos-Júnior³

et al. 2009

Arq. Neuro-Psiquiatr.

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“…It is strongly associated with increased mortality [6][7][8][9][10]. Hyperglycemia is also associated with increases in other negative clinical outcomes, including infection [11], sepsis and septic shock [10,12,13], myocardial infarction [2], and polyneuropathy and multi-organ failure [3,14].…”

Section: The Physiological and Clinical Problemmentioning

confidence: 99%

“…• Mortality increases with mean, maximum, and minimum and/or range of blood glucose in a range of cohorts [6][7][8][56][57][58][59].…”

Section: The Interrelationship Of Glycemia Tgc Patients and Outcomementioning

confidence: 99%

Tight glycemic control in critical care – The leading role of insulin sensitivity and patient variability: A review and model-based analysis

Chase

Compte

Suhaimi

et al. 2011

Computer Methods and Programs in Biomedicine

123

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Tight glycemic control (TGC) has emerged as a major research focus in critical care due to its potential to simultaneously reduce both mortality and costs. However, repeating initial successful TGC trials that reduced mortality and other outcomes has proven difficult with more failures than successes. Hence, there has been growing debate over the necessity of TGC, its goals, the risk of severe hypoglycemia, and target cohorts.This paper provides a review of TGC via new analyses of data from several clinical trials, including SPRINT, Glucontrol and a recent NICU study. It thus provides both a review of the problem and major background factors driving it, as well as a novel model-based analysis designed to examine these dynamics from a new perspective. Using these clinical results and analysis, the goal is to develop new insights that shed greater light on the leading factors that make TGC difficult and inconsistent, as well as the requirements they thus impose on the design and implementation of TGC protocols.A model-based analysis of insulin sensitivity using data from three different critical care units, comprising over 75,000 hours of clinical data, is used to analyse variability in metabolic dynamics using a clinically validated model-based insulin sensitivity metric (S I ). Variation in S I provides a new interpretation and explanation for the variable results seen (across cohorts and studies) in applying TGC. In particular, significant intra-and inter-patient variability in insulin resistance (1/ S I ) is seen be a major confounder that makes TGC difficult over diverse cohorts, yielding variable results over many published studies and protocols. Further factors that exacerbate this variability in glycemic outcome are found to include measurement frequency and whether a protocol is blind to carbohydrate administration.

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“…The first potential role for K ATP channels relates to their function in regulating insulin release in pancreatic β-cells. It is well established that hypoglycemia is associated with neurological abnormalities and seizures, and that hyperglycemia is associated with significantly poorer outcomes in stroke [19;20] and traumatic brain injury [21]. The second potential role for K ATP channels regards direct neuroprotection.…”

Section: Sur1-regulated K Atp Channelmentioning

confidence: 99%

Drugs acting on SUR1 to treat CNS ischemia and trauma

Simard

Woo

Bhatta

et al. 2008

Current Opinion in Pharmacology

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SUMMARYSulfonylurea receptor 1 (SUR1) is a molecule with more diverse and critically important functions than previously recognized. Long viewed simply as a subunit involved in formation of subset of K (ATP) channels, accumulating evidence indicates that SUR1 is newly upregulated in CNS ischemia and injury and is surprisingly promiscuous in its association with different pore-forming subunits, which endow it with new roles not previously envisioned. In this review, we focus on the SUR1-regulated NC(Ca-ATP) channel, its emerging role in CNS ischemia and trauma, and the growing evidence from preclinical and clinical studies demonstrating the potential importance of block of SUR1 by sulfonylureas such as glibenclamide (glyburide) in conditions as seemingly diverse as stroke and spinal cord injury.

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The Impact of Hyperglycemia on Patients With Severe Brain Injury

Abstract: Early hyperglycemia is associated with poor outcomes for patients with severe traumatic brain injury. Tighter control of serum glucose without reduction of nutritional support may improve the prognosis for these critically ill patients.

Cited by 320 publications

References 18 publications

Hyperglycemia in pediatric head trauma patients: a cross-sectional study

Hyperglycemia in pediatric head trauma patients: a cross-sectional study

Tight glycemic control in critical care – The leading role of insulin sensitivity and patient variability: A review and model-based analysis

Drugs acting on SUR1 to treat CNS ischemia and trauma

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