Document Detail

Intensive insulin therapy in severe traumatic brain injury: a randomized trial.
MedLine Citation:
PMID:  20032790     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Intensive insulin therapy (IIT) has been shown to reduce morbidity and mortality in critically ill patients. Little investigation has been done to find out whether it improves the prognosis of patients with severe traumatic brain injury (STBI). METHODS: We conducted a prospective controlled study where adult patients with blunt STBI, with Glasgow Coma Scale <or=8, admitted to the intensive care unit (ICU) were randomly assigned to receive either IIT (maintenance of blood glucose between 80 mg/dL and 110 mg/dL with continuous insulin infusion) or conventional glycemic therapy (CGT) (maintenance of blood glucose below 180 mg/dL with subcutaneous insulin and insulin infusion only if blood glucose levels exceeded 220 mg/dL). The main outcome was Glasgow outcome scale 6 months after trauma. Secondary measures were hypoglycemia, incidence of infections, and days in ICU. RESULTS: Of the 88 patients randomized, 42 were assigned to IIT and 46 to CGT. There was no difference (p = 0.63) in neurologic outcomes between the treatment groups: Glasgow outcome scale >3 was observed in 16 patients (41%) in the IIT and in 13 patients (32.5%) in the CGT group. More patients in the IIT group had hypoglycemia: 32 (82.1%), compared with 7 (17.5%) in the CGT group (p < 0.001). There were no differences in the number of days spent in the ICU (18.2 +/- 27.6 vs. 12.9 +/- 12.7) or in the sepsis rates (84.6% vs. 80%) between the groups. CONCLUSION: In our study, IIT did not improve the neurologic outcome of patients with STBI but did increase the risk of hypoglycemia compared with CGT.
Ariane Coester; Cristina Rolim Neumann; Maria In?s Schmidt
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Journal of trauma     Volume:  68     ISSN:  1529-8809     ISO Abbreviation:  J Trauma     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-04-13     Completed Date:  2010-05-06     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376373     Medline TA:  J Trauma     Country:  United States    
Other Details:
Languages:  eng     Pagination:  904-11     Citation Subset:  AIM; IM    
Programa de P?s-gradua??o em Epidemiologia, Universidade Federal do Rio Grande do Sul and Hospital de Pronto Socorro de Porto Alegre, Prefeitura Municipal de Porto Alegre, Porto Alegre, RS, Brazil.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Analysis of Variance
Blood Glucose / analysis
Brain Injuries / drug therapy*
Chi-Square Distribution
Critical Illness
Glasgow Coma Scale
Hypoglycemia / epidemiology
Infection / epidemiology
Insulin / therapeutic use*
Length of Stay / statistics & numerical data
Poisson Distribution
Prospective Studies
Treatment Outcome
Reg. No./Substance:
0/Blood Glucose; 11061-68-0/Insulin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Previous Document:  Safety and efficacy of combining sunitinib with bevacizumab + paclitaxel/carboplatin in non-small ce...
Next Document:  rFVIIa and NN1731 reduce bleeding in hydroxyethyl starch hemodiluted rabbits.