Ricerca avanzata

Home > Riviste > Minerva Anestesiologica > Fascicoli precedenti > Minerva Anestesiologica 2010 Novembre;76(11) > Minerva Anestesiologica 2010 Novembre;76(11):896-904



Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
Indexed/Abstracted in: Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 2,036

Periodicità: Mensile

ISSN 0375-9393

Online ISSN 1827-1596


Minerva Anestesiologica 2010 Novembre;76(11):896-904


Insulin differentially influences brain glucose and lactate in traumatic brain injured patients

Béchir M. 1, Meierhans R. 1, Brandi G. 1,2, Sommerfeld J. 1, Fasshauer M. 1, Cottini S. R. 1, Stocker R. 1, Stover J. F. 1

1 Surgical Intensive Care, University Hospital Zürich, Zürich, Switzerland;
2 Neurosurgical Intensive Care Unit; Department of Anesthesia and Critical Care Medicine; Ospedale Maggiore Policlinico IRCCS Foundation; Mangiagalli e Regina Elena, Milan, Italy

BACKGROUND: Hypo- and hyperglycemia must be avoided to prevent additional brain damage following traumatic brain injury (TBI). However, the optimal blood glucose range requiring insulin remains unknown. Cerebral microdialysis is helpful in unmasking signs of metabolic impairment, thereby identifying deleterious blood glucose levels.
METHODS: A retrospective analysis of prospectively collected cerebral microdialysis samples obtained from 20 non-diabetic patients with severe TBI treated at the trauma surgical intensive care unit at the University Hospital Zürich, Switzerland.
RESULTS: The impact of different arterial blood glucose values and concomitant insulin administration on cerebral interstitial glucose and lactate levels was investigated. In addition, energetic impairment was determined by calculating lactate-to-glucose ratios. Insulin administration was associated with significantly reduced cerebral glucose concentrations and significantly increased lactate-to-glucose ratios with arterial blood glucose levels <5 mM. At arterial blood glucose levels >7 mM, insulin administration was associated with significantly increased interstitial glucose values, significantly decreased lactate concentrations, and markedly diminished lactate-to-glucose ratios.
CONCLUSION: Insulin exerts differential effects that depend strongly on the underlying arterial blood glucose concentrations. To avoid energetic impairment, insulin should not be administered at arterial blood glucose levels <5 mM. However, at arterial blood glucose levels >7-8 mM, insulin administration appears to be encouraged to increase extracellular glucose concentrations and decrease energetic impairment reflected by reduced interstitial brain lactate and decreased lactate-to-glucose ratios. Nevertheless, frequent analysis is required to minimize the risk of inducing impaired brain metabolism.

lingua: Inglese


inizio pagina