Der Einfluss der intensivierten Insulintherapie auf Infektionen bei Patienten mit schwerer ZNS-Verletzung

PURPOSE: In our randomised prospective study from April 2003 to December 2004 of intensive care patients suffering from severe CNS injuries requiring prolonged mechanical ventilation, we have investigated the implementation of intensified insulin therapy to inflammatory parameters (CRP, Leukocytes, IL-6, PCT). Further aims of this study, were to see if it would be possible to reduce patients’ need for antibiotics, to reduce ventilation time and to decrease the number of septicemias.METHODS: A randomized prospective study of patients with CNS injuries requiring mechanical ventilatory support for at least 24h. After informed consent was obtained, patients were assigned to the intensified insulin therapy (glucose 80 –120 mg/dl) or to a standard regimen (180-220 mg/dl). Using a standardized treatment protocol, blood glucose levels were kept within the desired limits. C reactive protein (CRP), procalcitonin (PCT) and leukocyte counts were assessed daily. Additional parameters such as IL-6, were measured every third day. Furthermore the number of antibiotics, as well as the duration of their administration was assessed in both groups, as well as how long patients spent in the intensive care unit and their ventilation durations. RESULTS: So far a total of 108 patients have taken part in the study, from which 52 patients were assigned to the standard group (STD), and 56 patients to the intensified group (INT). All parameters were calculated over a time of 25 days. The mean CRP values were: 93.41 +/- 5.92 mg/L in the STD group, and 89.87 +/- 5.88 mg/L in the INT group. The median values for the PCT group were:0.33 ng/ml (STD) and 0.31 ng/ml (INT). The leukocyte count did not differ in both groups with a mean value of 12,5 +/- 4 G/L. There is no significant difference between both groups in relation to the inflammatory parameters and the frequency of infections (pneumonia 90%), but more frequent severe infections like bacteremia with 20% INT group and 8% STD group. Equally the mean number of antibiotics and the duration of treatment did not differ significantly in both groups. The 30 day mortality could not affected by the intensified insulin therapy. There died 20% of the STD- and 25% of the INT- group patients. To admit is the fact that hypoglycemia were significant more frequent observed with 16,1% in the INT patient group (versus 1,9% STD group).CONCLUSION: In contrast to previous studies showing a significant effect of intensified insulin therapy in patients with predominantly cardiovascular diseases, our preliminary data seems to indicate that this effect can not be achieved in patients with CNS injuries. The difference could be due to the different underlying diseases and comorbidity in both patient groups. Regarding neurosurgical patients, the difference could be that a moderate hyperglycemia may be necessary for the regeneration of damaged brain cell tissue. A further possible reason for the cause of infection in patients with severe CNS injuries, could be lying in a coma, a sedation and long ventilation periods.

Grantor dc:publisher

Publikationsserver der RWTH Aachen University

Year dc:date

2008

Author dc:creator

• Bertig, Susanne Sabine Anna-Elisabeth

Contributors dc:contributor

• Gilsbach, Joachim M.

• info:eu-repo/classification/ddc/610
• Insulin
• Allgemeine Entzündungsreaktion
• Intensivtherapie
• Zentralnervensystem
• Procalcitonin
• Interleukin 6
• Leukozyt
• C-reaktives Protein
• Medizin
• intensivierte Insulintherapie
• ZNS-Verletzung
• SIRS
• Postaggressionssyndrom
• BZ
• intensified insulin therapie
• CNS injuries
• infection
• blood glucose
• bacteremia

Statement dc:rights

• info:eu-repo/semantics/openAccess

Language dc:language

ger

Identifier

https://publications.rwth-aachen.de/search?p=id:%22RWTH-CONV-112784%22

OAI record oai:identifier

https://publications.rwth-aachen.de/oai2d?verb=GetRecord&metadataPrefix=oai_dc&identifier=oai%3Apublications.rwth-aachen.de%3A50231