Glucose management in the neurosurgical patient: are we yet any closer?
OBJECTIVE
This review focuses on recent findings in perioperative management of blood glucose control using intensive insulin therapy in neurosurgical and neurocritical care and in other intensive care unit patients. We also aim to address practical issues and make recommendations that may contribute to the safe clinical application of intensive insulin therapy targeted to optimize blood glucose control in these patients.


RESULTS
Intensive insulin therapy targeted to obtain tight blood glucose control induces a substantial increase in the number of hypoglycemic episodes and mortality rate. On the contrary, hyperglycemia--both isolated episodes and high mean glucose levels--is associated with worsened neurologic outcome and increased mortality.


CONCLUSIONS
In neurosurgical and neurocritical care as well as other intensive care unit patients, both hypoglycemia and hyperglycemia have significant adverse effects. The optimal glucose level remains under debate but significant steps have evolved with the call for judicious control and elimination of the historical approach to glycemic management, which underestimated drawbacks associated with dysglycemia. The increased incidence of hypoglycemia and mortality as well as the impact of hyperglycemia on worsening neurologic function in patients with acute brain damage heightens the need for more clinical studies on perioperative glucose management in these patients.
Bilotta
Federico
F
Department of Anesthesiology, Critical Care and Pain Medicine, Neuroanaesthesia and Neurocritical Care, 'Sapienza' University of Rome, Rome, Italy. bilotta@tiscali.it
Rosa
Giovanni
G
D001786:Blood Glucose / Q000378:metabolism*; D003422:Critical Care; D005947:Glucose / Q000627:therapeutic use; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy; D007003:Hypoglycemia / Q000188:drug therapy; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D019635:Neurosurgical Procedures / Q000379:methods*; D019990:Perioperative Care
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D005947:Glucose