nutritional support and brain tissue glucose metabolism in poor-grade sah a retrospective observational study营养支持和脑组织葡萄糖代谢低分sah回顾性观察研究.pdfVIP

Schmidt et al. Critical Care 2012, 16:R15 /content/16/1/R15 RESEARCH Open Access Nutritional support and brain tissue glucose metabolism in poor-grade SAH: a retrospective observational study 1* 1,2 1 1 3,4 1,2 J Michael Schmidt , Jan Claassen , Sang-Bae Ko , Hector Lantigua , Mary Presciutti , Kiwon Lee , E Sander Connolly2, Stephan A Mayer1,2, David S Seres3 and Neeraj Badjatia1,2 Abstract Introduction: We sought to determine the effect of nutritional support and insulin infusion therapy on serum and brain glucose levels and cerebral metabolic crisis after aneurysmal subarachnoid hemorrhage (SAH). Methods: We used a retrospective observational cohort study of 50 mechanically ventilated poor-grade (Hunt-Hess 4 or 5) aneurysmal SAH patients who underwent brain microdialysis monitoring for an average of 109 hours. Enteral nutrition was started within 72 hours of admission whenever feasible. Intensive insulin therapy was used to maintain serum glucose levels between 5.5 and 7.8 mmol/l. Serum glucose, insulin and caloric intake from enteral tube feeds, dextrose and propofol were recorded hourly. Cerebral metabolic distress was defined as a lactate to pyruvate ratio (LPR) 40. Time-series data were analyzed using a general linear model extended by generalized estimation equations (GEE). Results: Daily mean caloric intake received was 13.8 ± 6.9 cal/kg and mean serum glucose was 7.9 ± 1 mmol/l. A total of 32% of hourly recordings indicated a state of metabolic distress and 1% indicated a state of critical brain hypoglycemia ( 0.2 mmol/l). Calories received from enteral tube feeds were associated with higher serum glucose concentrations (Wald = 6.07, P = 0.048), more insulin adm