Glucose-insulin-potassium correlates with hemodynamic improvement in patients with septic myocardial dysfunction.
BACKGROUND
Glucose-insulin-potassium (GIK) demonstrates a cardioprotective effect by providing metabolic support and anti-inflammatory action, and may be useful in septic myocardial depression. The aim of this study was to examine the relationship between GIK and hemodynamic outcomes in septic shock patients with myocardial depression.


METHODS
Between October 2012 and March 2014, 45 patients in the intensive care unit who fulfilled the criteria for severe sepsis/septic shock and were treated with GIK were recruited. Patients were divided into two groups according to echocardiographic findings: hypodynamic (27%) and non-hypodynamic (36%).


RESULTS
Baseline vasopressor requirements did not differ between both groups. In 12 patients with hypodynamic septic shock with myocardial depression, mean arterial pressure (MAP) increased with the median [interquartile range (IQR)] area under the curve of 16 (8 to 29) mmHg, and the heart rate (HR) decreased with the median (IQR) area under the curve of -9 (-20 to 2)/min during the first 72 h. The total insulin dose correlated with improvement in MAP (r=0.61, P=0.061) and the cardiovascular Sequential Organ Failure Assessment score (r=-0.64, P=0.045) at 72 h, although this phenomenon was not observed in patients with non-hypodynamic septic shock. Serum glucose and potassium levels were within the target ranges in both groups during the 72-h study period.


CONCLUSIONS
Short-term improvement in hemodynamics correlated with GIK administration in septic shock patients with myocardial depression. The use of GIK was well tolerated in all patients. Further studies are required to demonstrate the role of GIK in septic myocardial dysfunction.
Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Won-Young
WY
Kim
Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Moon Seong
MS
Baek
Department of Pharmacy, Asan Medical Center, Seoul, Korea.
Young Shin
YS
Kim
Department of Pharmacy, Asan Medical Center, Seoul, Korea.
Jarim
J
Seo
Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Jin Won
JW
Huh
Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Chae-Man
CM
Lim
Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Younsuck
Y
Koh
Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Sang-Bum
SB
Hong
Glucose; hemodynamics; insulin; sepsis; septic shock