Glucose control after severe brain injury.
OBJECTIVE
A substantial body of evidence supports the use of intensive insulin therapy in general critical care practice, particularly in surgical intensive care unit patients. The impact of intensive insulin therapy on the outcome of critically ill neurological patients, however, is still controversial. While avoidance of hyperglycemia is recommended in neurointensive care, no recommendations exist regarding the optimal target for systemic glucose control after severe brain injury.


RESULTS
An increase in brain metabolic demand leading to a deficiency in cerebral extracellular glucose has been observed in critically ill neurological patients and correlates with poor outcome. In this setting, a reduction of systemic glucose below 6 mmol/l with exogenous insulin has been found to exacerbate brain metabolic distress. Recent studies have confirmed these findings while showing intensive insulin therapy to have no substantial benefit on the outcome of critically ill neurological patients.


CONCLUSIONS
Questions persist regarding the optimal target for glucose control after severe brain injury. Further studies are needed to analyze the impact of intensive insulin therapy on brain glucose metabolism and outcome of critically ill neurological patients. According to the available evidence, a less restrictive target for systemic glucose control (6-10 mmol/l) may be more appropriate.
Oddo
Mauro
M
Division of Neurocritical Care, Columbia University Medical Center, New York, USA. Mauro.Oddo@uphs.upenn.edu
Schmidt
J Michael
JM
Mayer
Stephan A
SA
Chioléro
René L
RL
D001786:Blood Glucose / Q000378:metabolism*; D001930:Brain Injuries / Q000378:metabolism*; D003422:Critical Care / Q000379:methods; D016638:Critical Illness; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D011379:Prognosis; D016896:Treatment Outcome
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin