Optimal glycemic control in neurocritical care patients: a systematic review and meta-analysis.

摘要: Hyper- and hypoglycemia are strongly associated with adverse outcomes in critical care. Neurologically injured patients a unique subgroup, where optimal glycemic targets may differ, such that the findings of clinical trials involving heterogeneous critically ill not apply. We performed systematic review meta-analysis randomized controlled (RCTs) comparing intensive insulin therapy conventional control among traumatic brain injury, ischemic or hemorrhagic stroke, anoxic encephalopathy, central nervous system infections spinal cord injury. Sixteen RCTs, 1248 neurocritical care patients, were included. Glycemic ranged from 70-140 mg/dl (3.9-7.8 mmol/L), while protocols aimed to keep glucose levels below 144-300 (8.0-16.7 mmol/L). Tight had no impact on mortality (RR 0.99; 95% CI 0.83-1.17; p = 0.88), but did result fewer unfavorable neurological 0.91; 0.84-1.00; 0.04). However, improved only observed when group permitted be relatively high [threshold for administration > 200 (> 11.1 mmol/L)], more intermediate 140-180 (7.8-10.0 mmol/L)]. Hypoglycemia was far common 3.10; 1.54-6.23; 0.002), there large degree heterogeneity results individual (Q 47.9; 33%) 1.17; 0.79-1.75; 0.44). Intensive significantly increases risk does influence patients. Very loose is worse recovery should avoided. These suggest goals most appropriate.