Evolution of insulin sensitivity and its variability in out-of-hospital cardiac arrest OHCA patients treated with hypothermiaReport as inadecuate




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Critical Care

, 18:586

First Online: 28 October 2014Received: 25 May 2014Accepted: 10 October 2014

Abstract

IntroductionTherapeutic hypothermia TH is often used to treat out-of-hospital cardiac arrest OHCA patients who also often simultaneously receive insulin for stress-induced hyperglycaemia. However, the impact of TH on systemic metabolism and insulin resistance in critical illness is unknown. This study analyses the impact of TH on metabolism, including the evolution of insulin sensitivity SI and its variability, in patients with coma after OHCA.

MethodsThis study uses a clinically validated, model-based measure of SI. Insulin sensitivity was identified hourly using retrospective data from 200 post-cardiac arrest patients 8,522 hours treated with TH, shortly after admission to the intensive care unit ICU. Blood glucose and body temperature readings were taken every one to two hours. Data were divided into three periods: 1 cool T <35°C; 2 an idle period of two hours as normothermia was re-established; and 3 warm T >37°C. A maximum of 24 hours each for the cool and warm periods was considered. The impact of each condition on SI is analysed per cohort and per patient for both level and hour-to-hour variability, between periods and in six-hour blocks.

ResultsCohort and per-patient median SI levels increase consistently by 35% to 70% and 26% to 59% P <0.001 respectively from cool to warm. Conversely, cohort and per-patient SI variability decreased by 11.1% to 33.6% P <0.001 for the first 12 hours of treatment. However, SI variability increases between the 18th and 30th hours over the cool to warm transition, before continuing to decrease afterward.

ConclusionsOCHA patients treated with TH have significantly lower and more variable SI during the cool period, compared to the later warm period. As treatment continues, SI level rises, and variability decreases consistently except for a large, significant increase during the cool to warm transition. These results demonstrate increased resistance to insulin during mild induced hypothermia. Our study might have important implications for glycaemic control during targeted temperature management.

Abbreviations%ΔSIhour-to-hour percentage changes in insulin sensitivity

BGblood glucose

CDFcumulative distribution function

ICUintensive care unit

IQRinterquartile range

KSKolmogorov-Smirnov test

OHCAout-of-hospital cardiac arrest

SIinsulin sensitivity metric model-based

SPRINTspecialized relative insulin and nutrition titration

THtherapeutic hypothermia

Electronic supplementary materialThe online version of this article doi:10.1186-s13054-014-0586-x contains supplementary material, which is available to authorized users.

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Author: Azurahisham Sah Pri - J Geoffrey Chase - Christopher G Pretty - Geoffrey M Shaw - Jean-Charles Preiser - Jean-Louis Vince

Source: https://link.springer.com/







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