Artikel
Intensified insulin therapy and infection in patients with severe injury to the CNS
Einfluss der intensivierten Insulintherapie auf Infektionen bei Patienten mit schweren Verletzungen des ZNS
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Veröffentlicht: | 4. Mai 2005 |
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Gliederung
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Objective
In a previous study with intensive care patients suffering predominantly from cardiovascular disease requiring prolonged mechanical ventilation the implementation of intensified insulin therapy reduced the need for antibiotics and decrease the number of septicemias. Aim of the current study was to compare the influence of intensified insulin therapy on inflammatory parameters and the need for antibiotic therapy in patients with severe injury to the CNS.
Methods
Prospective randomised study of patients with CNS injury 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) and a standard regimen (180-220 mg/dl). Using a standardised treatment protocol blood glucose levels were kept within the desired limits. C reactive protein (CRP), procalcitonin (PCT) and leukocyte count 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.
Results
So far a total of 108 patients could be included in the study. 52 patients were assigned to the standard group (STD), 56 patients to the intensified group (INT). Mean CRP was 90.9±40.0 mg/L in STD and 87.3±42.9mg/L in INT, PCT was 0.7±1.9 and 1.0±2.1 respectively. Leukocytes count did not differ in both groups (STD:12.5±0.5, INT: 12.6±6.7 G/L). In both groups a mean number of 2 different antibiotics was given with a median total duration of 13 days in the STD and 16 days in the INT.
Conclusions
In contrast to previous studies showing a significant effect of intensified insulin therapy in patients with predominantly cardiovascular disease our preliminary data seem to indicate that this effect may not be achieved in patients with injury to the CNS. The difference could be due to the different underlying disease and comorbidity in both patient populations.