Permanent URL to this publication: http://dx.doi.org/10.5167/uzh-36224
Béchir, M; Meierhans, R; Brandi, G; Sommerfeld, J; Fasshauer, M; Cottini, S R; Stocker, R; Stover, J F (2010). Insulin differentially influences brain glucose and lactate in traumatic brain injured patients. Minerva Anestesiologica, 76(11):896-904.
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AIM: Hypo- and hyperglycemia must be avoided to prevent additional brain damage following traumatic brain injury (TBI). However, the optimal blood glucose range requiring insulin remains unknown. Cerebral microdialysis is helpful in unmasking signs of metabolic impairment, thereby identifying deleterious blood glucose levels. METHODS: A retrospective analysis of prospectively collected cerebral microdialysis samples obtained from 20 non-diabetic patients with severe TBI treated at the trauma surgical intensive care unit at the University Hospital Zürich, Switzerland. RESULTS: The impact of different arterial blood glucose values and concomitant insulin administration on cerebral interstitial glucose and lactate levels was investigated. In addition, energetic impairment was determined by calculating lactate-to-glucose ratios. Insulin administration was associated with significantly reduced cerebral glucose concentrations and significantly increased lactate-to-glucose ratios with arterial blood glucose levels <5 mM. At arterial blood glucose levels >7 mM, insulin administration was associated with significantly increased interstitial glucose values, significantly decreased lactate concentrations, and markedly diminished lactate-to-glucose ratios. CONCLUSION: Insulin exerts differential effects that depend strongly on the underlying arterial blood glucose concentrations. To avoid energetic impairment, insulin should not be administered at arterial blood glucose levels <5 mM. However, at arterial blood glucose levels >7-8 mM, insulin administration appears to be encouraged to increase extracellular glucose concentrations and decrease energetic impairment reflected by reduced interstitial brain lactate and decreased lactate-to-glucose ratios. Nevertheless, frequent analysis is required to minimize the risk of inducing impaired brain metabolism.
|Item Type:||Journal Article, refereed, original work|
|Communities & Collections:||04 Faculty of Medicine > University Hospital Zurich > Division of Surgical Research|
04 Faculty of Medicine > University Hospital Zurich > Institute of Anesthesiology
|DDC:||610 Medicine & health|
|Deposited On:||15 Nov 2010 14:53|
|Last Modified:||15 Dec 2012 07:58|
|Publisher:||Edizioni Minerva Medica|
|Free access at:||PubMed ID. An embargo period may apply.|
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