Intensive insulin therapy in severe traumatic brain injury: a randomized trial.
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.


CONCLUSIONS
In our study, IIT did not improve the neurologic outcome of patients with STBI but did increase the risk of hypoglycemia compared with CGT.
Coester
Ariane
A
Programa de Pós-graduação 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. arianecoester@yahoo.com.br
Neumann
Cristina Rolim
CR
Schmidt
Maria Inês
MI
D000704:Analysis of Variance; D001786:Blood Glucose / Q000032:analysis; D001930:Brain Injuries / Q000188:drug therapy*; D016009:Chi-Square Distribution; D016638:Critical Illness; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007003:Hypoglycemia / Q000453:epidemiology; D007239:Infections / Q000453:epidemiology; D007328:Insulin / Q000627:therapeutic use*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D016012:Poisson Distribution; D011379:Prognosis; D011446:Prospective Studies; D016896:Treatment Outcome
D001786:Blood Glucose; D007328:Insulin