| Increased blood glucose variability during therapeutic hypothermia and outcome after cardiac arrest. | |
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MedLine Citation:
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PMID: 21705888 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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OBJECTIVE:: Hypothermia impairs blood glucose homeostasis and insulin sensitivity. However, the impact of therapeutic hypothermia on blood glucose levels and insulin requirements is unknown. We analyzed blood glucose variability during therapeutic hypothermia in patients with coma after cardiac arrest and examined its impact on outcome. DESIGN:: Prospective observational study. SETTING:: Two university hospital medical/surgical intensive care units. PATIENTS:: Comatose cardiac arrest patients treated with therapeutic hypothermia (33°C, 24 hrs). INTERVENTIONS:: Insulin therapy (blood glucose target 6-8 mmol/L [110-150 mg/dL]), according to a written algorithm, with nurse-driven adjustment of insulin dose. MEASUREMENTS AND MAIN RESULTS:: Two-hundred and twenty patients (median age 61 yrs, median time to return of spontaneous circulation 20 min) were studied. Two time periods, comparable in duration, were categorized: therapeutic hypothermia (stable maintenance phase) and normothermia (after rewarming). Blood glucose variability was defined as the difference between maximum and minimum blood glucose concentration during each time period. Mean blood glucose (8.3 ± 2.3 vs. 7.1 ± 1.3 mmol/L), blood glucose variability (5.7 ± 3.9 vs. 3.7 ± 3.6 mmol/L), and insulin dose (2 ± 2 vs. 1 ± 1 U/h) were higher during therapeutic hypothermia compared to normothermia (all p < .001). Higher mean blood glucose (7.9 ± 1.8 mmol/L in survivors vs. 8.7 ± 2.6 mmol/L in nonsurvivors, p = .02) and increased blood glucose variability (4.9 ± 3.5 vs. 6.5 ± 4.1 mmol/L, p = .003) during therapeutic hypothermia were associated with mortality. After adjusting for time to return of spontaneous circulation, initial arrest rhythm, and cardiac arrest etiology, increased blood glucose variability during therapeutic hypothermia, but not mean blood glucose level, was an independent predictor of inhospital mortality (odds ratio for death 1.10 [confidence interval 1.02-1.19], p = .016). CONCLUSIONS:: Mild therapeutic hypothermia is associated with higher blood glucose levels, increased blood glucose variability, and greater insulin requirements compared to the postrewarming normothermic phase. Increased blood glucose variability during therapeutic hypothermia is a predictor of inhospital mortality after cardiac arrest, independent of injury severity and mean blood glucose levels. |
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Authors:
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Nadine Cueni-Villoz; Alessandro Devigili; Frederik Delodder; Silvia Cianferoni; François Feihl; Andrea O Rossetti; Philippe Eggimann; Jean-Louis Vincent; Fabio S Taccone; Mauro Oddo |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-6-23 |
Journal Detail:
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Title: Critical care medicine Volume: - ISSN: 1530-0293 ISO Abbreviation: - Publication Date: 2011 Jun |
Date Detail:
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Created Date: 2011-6-27 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0355501 Medline TA: Crit Care Med Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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From the Departments of Intensive Care Medicine (NCV, FD, PE, MO) and Clinical Neurosciences (AOR), and Division of Clinical Pathophysiology (FF), Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne University Hospital and Faculty of Biology and Medicine, Lausanne, Switzerland; and the Department of Intensive Care (AD, SC, JLV, FST), Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium. |
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