39268
document
Intensive insulin therapy on infection rate , days in NICU , in-hospital mortality and neurological outcome in severe traumatic brain injury patients : a randomized controlled trial . OBJECTIVES Evaluate the impact of an intensive insulin therapy and conventional glucose control protocol during staying in neurological intensive care unit ( NICU ) on infection rate , days in NICU , in-hospital mortality and long-term neurological outcome in severe traumatic brain injury ( TBI ) patients . METHODS A total of 240 patients with severe TBI ( GCS score 3-8 ) admitted to NICU were prospectively enrolled and randomly assigned either to conventional insulin therapy or to intensive insulin therapy . Patients in intensive glucose control group ( n=121 ) received continuous insulin infusion to maintain glucose levels between 4.4 m mol/l ( 80 mg/dl ) and 6.1 m mol/l ( 110 mg/dl ) . Patients in the conventional treatment group ( n=119 ) were not given insulin unless glucose levels were greater than 11.1 m mol/l ( 200mg/dl ) . Both groups were treated with insulin infusion to maintain normoglycemia after leaving NICU . Comparison was made against conventional insulin therapy using a randomized trial design . The primary outcomes is the mortality rate at 6 months follow-up . The second outcomes including ICU infection rate , duration of ICU stay , in-hospital mortality rate and neurologic outcome at 6 months follow-up . RESULTS There was no significant difference in gender ( 66 % vs. 67 % male ) , age ( 46+/-11 years vs. 45+/-10 years ) , APACHE II score ( 30 vs. 29 ) , TISS-28 score ( 47 vs. 46 ) , and Glasgow Coma Score ( GCS , 5.3 vs. 5.3 ) between the two groups . Overall mortality rates at 6 months follow-up were similar in the 2 groups ( 61 of 117 , 52.1 % vs. 62 of 116 , 53.4 % ; P=0.8 ) . The infection rate during the study was significantly higher in patients who received conventional insulin therapy than that in patients who received intensive insulin therapy ( 46.2 % vs. 31.4 % ; P < 0.05 ) . The days stay in NICU was shorter in intensive insulin control group than that in conventional therapy group [ 4.2 days vs. 5.6 days ( medians ) P < 0.05 ] . The in-hospital mortality during the study was similar in conventional and intensive therapy groups ( 34 of 119 , 28.6 % vs. 35 of 121 , 28.9 % in the conventional and intensive insulin therapy groups ; P=0.85 ) . The neurologic outcome according to Glasgow Outcome Score ( GOS ) at 6 months ( GOS 5 and 4 ) was better in the intensive insulin therapy group ( 34 of 117 , 29.1 % ) than that in the conventional therapy group ( 26 of 116 , 22.4 % , P < 0.05 ) . CONCLUSIONS Mortality rates at 6 months follow-up are not affected by intensive glucose control in patients with severe TBI . Intensive insulin therapy decreases infection rate and days in NICU and improves the neurological outcome at 6 months follow-up , while has no obvious influence on in-hospital mortality of severe TBI patients .
39269
Intervention_Pharmacological
Intensive insulin therapy
39270
Intervention_Pharmacological
intensive insulin therapy
39271
Intervention_Pharmacological
conventional glucose control protocol
39272
Intervention_Pharmacological
conventional insulin therapy
39273
Intervention_Pharmacological
intensive insulin therapy
39274
Intervention_Pharmacological
intensive glucose control group
39275
Intervention_Pharmacological
continuous insulin infusion
39276
Intervention_Pharmacological
conventional treatment group
39277
Intervention_Pharmacological
insulin
39278
Intervention_Pharmacological
insulin
39279
Intervention_Pharmacological
conventional insulin therapy
39280
Intervention_Pharmacological
conventional insulin therapy
39281
Intervention_Pharmacological
intensive insulin therapy
39282
Intervention_Pharmacological
intensive insulin
39283
Intervention_Pharmacological
conventional therapy
39284
Intervention_Pharmacological
conventional
39285
Intervention_Pharmacological
intensive therapy
39286
Intervention_Pharmacological
conventional
39287
Intervention_Pharmacological
intensive insulin therapy
39288
Intervention_Pharmacological
conventional therapy
39289
Intervention_Pharmacological
Intensive insulin therapy
39290
Outcome_Mortality
in-hospital mortality
39291
Outcome_Physical
neurological outcome
39292
Outcome_Adverse-effects
infection rate
39293
Outcome_Physical
,
39294
Outcome_Other
days in NICU
39295
Outcome_Mortality
in-hospital mortality
39296
Outcome_Physical
long-term neurological outcome
39297
Outcome_Physical
glucose levels
39298
Outcome_Mortality
mortality rate
39299
Outcome_Physical
ICU infection rate
39300
Outcome_Other
duration of ICU stay
39301
Outcome_Mortality
in-hospital mortality rate
39302
Outcome_Physical
neurologic outcome
39303
Outcome_Physical
TISS-28 score
39304
Outcome_Physical
Glasgow Coma Score
39305
Outcome_Mortality
Overall mortality rates
39306
Outcome_Physical
infection rate
39307
Outcome_Other
days stay in NICU
39308
Outcome_Mortality
in-hospital mortality
39309
Outcome_Physical
Glasgow Outcome Score ( GOS )
39310
Outcome_Mortality
Mortality rates
39311
Outcome_Physical
infection rate
39312
Outcome_Other
days in NICU
39313
Outcome_Physical
neurological outcome
39314
Outcome_Mortality
in-hospital mortality