Glycemic control in induced moderate prolonged hypothermia for acute brain injury

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  • February 26, 2019
Creator
  • Chiang, Juinting
    • Affiliation: Eshelman School of Pharmacy
Abstract
  • Acute brain injury is a major cause of death and disability with one of the most damaging aspects being elevated intracranial pressure (ICP). In patients with refractory elevated ICP, methods such as induced therapeutic hypothermia (TH) are often utilized for several days. It has also been shown that hyperglycemia and glucose variability are associated with poor neurologic outcomes in patients with acute brain injury. This is of further concern in patients undergoing TH as TH has been shown to cause a decrease in insulin production and increased insulin resistance. However, current literature only exists in post-cardiac arrest patients who underwent hypothermia for 24 hours. The effects of TH over several days on glycemic control are unknown. This study will examine the effects of prolonged TH in patients with acute brain injury on glycemic control. This is a retrospective cohort study of adult patients with acute brain injury admitted to UNC Hospitals from May 2010 to August 2013 who underwent TH for >24 hours. Exclusion criteria included history of type 1 diabetes, presentation with DKA or HHS, or administration of steroids for >24 hours or TPN. Data was collected at baseline and across four phases for TH patients (pre-TH, induction, maintenance, rewarming and post-TH) and across three phases for CN patients (pre-CN, CN phase, and post-CN). Sixteen patients met inclusion criteria. The mean age was 41±18 years and TBI accounted for 56.3% of the admitting diagnoses. The mean days from injury to cooling was 2.8±2.4 days. Median BG (143±25.5 vs. 110±35.25 vs. 116.5±28.8 mg/dL) and BG variability (82±71 vs. 46±53 vs. 61±29 mg/dL) were higher during pre-TH compared to TH and post-TH, respectively. Nine patients during pre-TH and TH and 7 patients during post-TH required insulin.
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  • In Copyright
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  • Funding: None
Advisor
  • Rhoney, Denise
Degree
  • Doctor of Pharmacy
Honors level
  • Highest Honors
Degree granting institution
  • University of North Carolina at Chapel Hill
Extent
  • 9

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