Abstract
Study aim
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 6 h 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 ± 3.22 mmol/L and 6.54 ± 2.45 mmol/L; p < 0.01 during cooling and rewarming, respectively. Twelve (32.4%) patients experienced
at least one hypoglycemic event, defined as a blood glucose <4 mmol/L. Nineteen (51.4%) patients experienced at least one hyperglycemic event, defined
as a blood glucose >11.11 mmol/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 ± 4.65 mmol/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 ± 12.5 units/h, respectively.
Conclusion
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.
Keywords
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Article info
Publication history
Published online: January 16, 2015
Accepted:
January 3,
2015
Received in revised form:
December 12,
2014
Received:
July 15,
2014
Footnotes
☆Presented at the 40th Critical Care Congress of the Society of Critical Care Medicine, San Diego, CA, January 2011.
☆☆A Spanish translated version of the abstract of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2015.01.002.
Identification
Copyright
© 2015 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
