Effects Of Moderate Blood Glucose On Patients In The Neurocritical Care Unit

Backgrounds and Objectives： Hyperglycemia is strongly associated with adverseoutcomes and mortality in the hospital patients, especially the critically ill, who are alwayshave hyperglycemia. And previous study of intensive insulin therapy to keep blood glucoselevels from80to110mg/dl (4.4-6.1mmol/L) can reduce morbidity and mortality amongcritically ill patients, more evidences show significant increase of hypoglycemia withintensive insulin therapy.Moderate intensive insulin therapy is proposed which has the same benefit but seems notto be limited by an increased risk of severe hypoglycemia. Neurocritical care patients are aunique subgroup, where optimal glycemic targets may differ, the blood glucose levels andthe application of intensive insulin therapy is controversial. Therefore, we performed arandomized controlled trial to investigate the perfect moderate intensive insulin therapy,comparing with convetional glycemia control to evaluate the safety and effectiveness, themetabolism of albumin, days in NICU, in-hospital infection rate, the tracheal intubation andtracheotomy, the time and days of mechanical ventilation, motality and30days neurologicaloutcome of the moderate insulin therapy on the patients in the neurointensive care unit.Methods: we perfomed a prospective, randomized,controlled study invoving187adultadmitted to the neurology intensive care unit in the fisrt hospital of jilin university from Mar2013to Jan2014. On admission, patients were randomly assigned to receive moderateintensive insulin therapy [maintenance of blood glucose at a level between110and150mgper deciliter (6.1and8.3mmol per liter)]or conventional treatment [infusion of insulin onlyif the blood glucose level exceeded200mg per deciliter (11.1mmol per liter) andmaintenance of glucose at a level between150and180mg per deciliter (8.3and10.0mmolper liter)] for7days, then both at the same level between150and180mg per deciliter.Results：With a total of95patients enrolled,30days later moderate intensive insulintherapy reduced in-hospital infection rate during intensive care from67.3percent with conventional treatment to46.5percent (P<0.05), patients receiving morderate intensivetherapy were less likely to require the tracheal intubation and tracheotomy[16/43(37.21%)vs.31/52(59.62%)，p＜0.05]. One week later the albumin levels of the two groups are lowerthan the beginning, patients receiving conventional therapy were more likely to decrease(4.77/6.96g/L，p＜0.05). And there was no significantly difference in the proportion ofpatients developing hypoglycemia [1/43vs.1/52，p＞0.05].But morderate intensive therapyhad no impact on mortality [13/43(30.23%) vs.20/52(38.46%)，p＞0.05] and the30daysneurological outcomes (3.3vs.3.72， p＞0.05), nor the time and days of mechanicalventilation (3.94/15.63days vs.5.34/16.24days，p＞0.05) and days in the intensive care unitand in-hospital (14.28/17.60days vs.15.13/18.29days，p＞0.05）.Conclusions: Moderate intensive insulin therapy does not influence days in NICU,mortality and30days neurological recovery among neurocritical care patients, nor does thetherapy increases the risk of hypoglycemia. But it indeed reduce the in-hospital infection rateand the tracheal intubation, tracheotomy and the decrease of albumin level. These resultssuggest that according to the continuous glucose monitoring, I.V moderate insulin therapyon the neurointensive care unit is safe and glycemic goals aim at6.1-8.3mmol/L(110-150mg/dl) in the neurocritical care patients may be most appropriate.