Risk factors for hypoglycaemia in neurocritical care patients

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• 作者：Freya M. van Iersel (1)
  Arjen J. C. Slooter (1)
  Renee Vroegop (1)
  Annemiek E. Wolters (1)
  Charlotte A. M. Tiemessen (1)
  Rik H. J. R?sken (1)
  Johannes G. van der Hoeven (2)
  Linda M. Peelen (3)
  Cornelia W. E. Hoedemaekers (2)
  
• 关键词：Hypoglycaemia ; Insulin ; Intensive care units ; Nervous system diseases ; Risk factors
• 刊名：Intensive Care Medicine
• 出版年：2012
• 出版时间：December 2012
• 年：2012
• 卷：38
• 期：12
• 页码：1999-2006
• 全文大小：196KB
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• 作者单位：Freya M. van Iersel (1)
  Arjen J. C. Slooter (1)
  Renee Vroegop (1)
  Annemiek E. Wolters (1)
  Charlotte A. M. Tiemessen (1)
  Rik H. J. R?sken (1)
  Johannes G. van der Hoeven (2)
  Linda M. Peelen (3)
  Cornelia W. E. Hoedemaekers (2)
  
  1. Department of Intensive Care Medicine, University Medical Center, P.O. Box 85500, Room F.06.149, 3508 GA, Utrecht, The Netherlands
  2. Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
  3. Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
  

文摘

Purpose To identify risk factors for hypoglycaemia in neurocritical care patients receiving intensive insulin therapy (IIT). Methods We performed a nested case–control study. All first episodes of hypoglycaemia (glucose <80?mg/dL, <4.4?mmol/L) in neurocritical care patients between 1 March 2006 and 31 December 2007 were identified. Patients were treated according to the local IIT protocol, with target blood glucose levels between 4.5 and 6.0?mmol/L (81.0-08.0?mg/dL). The first hypoglycaemic event of every patient (index moment) was used to match to a control patient. Possible risk factors preceding the index moment were scored using hospital records and analysed with conditional logistic regression. Results Of 786 neurocritical care patients, 449 developed hypoglycaemia (57.1?%). Independent risk factors for hypoglycaemia were lowering nutrition 6?h before the index moment without insulin dose reduction (odds ratio (OR) 5.25, 95?% confidence interval (95?% CI) 1.32-0.88), mechanical ventilation (OR 2.59, 95?% CI 1.56-.29), lowering the dosage of norepinephrine 3?h before the index moment (OR 2.44, 95?% CI 1.07-.55), a hyperglycaemic event (>10?mmol/L,?>180.0?mg/dL) in the 24?h preceding the index moment (OR 2.40, 95?% CI 1.26-.58), gastric residual in the 6?h preceding the index moment without insulin dose reduction (OR 1.76, 95?% CI 1.05-.96) and dosage of insulin at the index moment (OR 0.83, 95?% CI 0.76-.90). Conclusion Hypoglycaemia occurs in a considerable proportion of neurocritical care patients. We recommend the identification of these risk factors in these patients to avoid the occurrence of hypoglycaemia.