Hyperglycemia common during craniotomy for traumatic brain injury
MedWire News: Hyperglycemia occurs in more than one in 10 adult patients undergoing craniotomy for traumatic brain injury, shows US research.
"The high prevalence of hyperglycemia suggests that the intra-operative period may be a possible therapeutic window for initiating insulin treatment for achieving glycemic control in these patients," say Monica Vavilala (University of Washington, Seattle) and colleagues.
The researchers defined intra-operative hyperglycemia as a glucose level of 200 mg/dl or higher. According to this definition, hyperglycemia occurred in 15% of 185 patients who underwent craniotomy for traumatic brain injury during the 3-year study period.
The team notes that although frequently used, this definition is still arbitrary, and selecting a lower cutoff would have given a much higher rate of hyperglycemia - 45% at a cutoff of 150 mg/dl, for example.
Patients with hyperglycemia immediately before surgery were significantly more likely than those without to have intra-operative hyperglycemia. But patients' immediate pre-operative glucose levels did not predict their intra-operative levels, and there was significant within-patient and between-patient variability in intra-operative levels.
"Therefore, there may be a need for frequent and possibly continuous glucose monitoring in adults who have craniotomy for traumatic brain injury," say Vavilala et al in the journal Anesthesia and Analgesia.
Besides pre-operative hyperglycemia, having severe traumatic brain injury, subdural hematoma, and age of 65 years or older independently raised patients' risk for intra-operative hyperglycemia.
Intra-operative hyperglycemia also appeared to relate to patient outcomes, with 31% of those with versus 13% of those without hyperglycemia dying in hospital. Also, the average maximum intra-operative glucose level was significantly higher in patients who died than in those who survived to discharge, at 179 versus 151 mg/dl.
"Moreover, patients who received intra-operative insulin for treatment of hyperglycemia had lower in-hospital mortality than those not receiving insulin," say the researchers, although they caution that their finding is based on just 28 patients who died and 14 who were given insulin.
"Confounders of outcome could not be completely addressed and definitive conclusions about the importance of the intra-operative period cannot be made," says the team.
"However, these preliminary observations may warrant further examination to understand the potential impact of the intra-operative period on outcomes after traumatic brain injury."
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By Eleanor McDermid