title: Evaluation of glucose management during therapeutic hypothermia at a Tertiary Academic Medical Center.
abstract: OBJECTIVE
  Alterations in metabolic function during therapeutic hypothermia (TH) decrease responsiveness to insulin and increase the risk of hyperglycemia. Glycemic control is associated with improved outcomes in selected patients; however, glycemic management strategies during TH are not defined. The objective of this analysis was to evaluate the glycemic metrics and IV insulin administration in critically ill patients during the cooling and rewarming phases of TH.
  
  
  METHODS
  Data from 37 patients who received at least 6h of therapeutic hypothermia for cardiac arrest between January 2007 and January 2010 were retrospectively evaluated, 14 (37.8%) of whom had diabetes.
  
  
  RESULTS
  The mean blood glucose was 9.16±3.22mmol/L and 6.54±2.45mmol/L; p<0.01 during cooling and rewarming, respectively. Twelve (32.4%) patients experienced at least one hypoglycemic event, defined as a blood glucose <4mmol/L. Nineteen (51.4%) patients experienced at least one hyperglycemic event, defined as a blood glucose >11.11mmol/L and 15 (40.5%) patients received IV insulin therapy. Patients on IV insulin had a higher incidence of diabetes (9 vs. 5; p<0.05), higher admission blood glucose (13.89±6.13 vs. 11.03±4.65mmol/L; p=0.11), and a higher incidence of hyperglycemia (14 vs. 2; p<0.01) and hypoglycemia (8 vs. 4; p<0.05). Of the patients on IV insulin, mean insulin requirements during cooling and rewarming were 15.2±16.1 and 7±12.5units/h, respectively.
  
  
  CONCLUSIONS
  TH is commonly associated with hyperglycemia, hypoglycemia, and the use of IV insulin therapy. Further research is needed to determine optimal glycemic management strategies to prevent hyper- and hypoglycemia in patients during the different phases of TH.
authors.affiliation: Department of Pharmacy, UMass Memorial Medical Center, Worcester, MA, United States.
authors.forename: Allison A
authors.initials: AA
authors.lastname: Forni
authors.affiliation: Department of Pharmacy, Brigham and Women's Hospital, Boston, MA, United States.
authors.forename: Megan A
authors.initials: MA
authors.lastname: Rocchio
authors.affiliation: Department of Pharmacy, Brigham and Women's Hospital, Boston, MA, United States. Electronic address: pszumita@partners.org.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Szumita
authors.affiliation: Department of Pharmacy, Brigham and Women's Hospital, Boston, MA, United States.
authors.forename: Kevin E
authors.initials: KE
authors.lastname: Anger
authors.affiliation: Nursing Services, Brigham and Women's Hospital, Boston, MA, United States.
authors.forename: Kathleen Ryan
authors.initials: KR
authors.lastname: Avery
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, United States.
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Scirica
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D003422:Critical Care; D005260:Female; D006323:Heart Arrest / Q000097:blood / Q000628:therapy*; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis / Q000517:prevention & control*; D007003:Hypoglycemia / Q000175:diagnosis / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007036:Hypothermia, Induced / Q000009:adverse effects*; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: Glucose; Hyperglycemia; Hypoglycemia; Therapeutic hypothermia