tailieunhanh - Báo cáo y học: " Intensive glycemic control in traumatic brain injury: what is the ideal glucose range"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Intensive glycemic control in traumatic brain injury: what is the ideal glucose range? | Available online http content 12 5 175 Commentary Intensive glycemic control in traumatic brain injury what is the ideal glucose range Paul M Vespa Departments of Neurosurgery and Neurology David Geffen School of Medicine at UCLA 757 Westwood Blvd Suite 6236A Los Angeles CA 90095 USA Corresponding author Paul M Vespa Pvespa@ Published 1 September 2008 This article is online at http content 12 5 175 2008 BioMed Central Ltd Critical Care 2008 12 175 doi cc6986 See related research by Meier et al. http content 12 4 R98 Abstract Intensive glycemic control has become standard practice. Existing data however suggest this practice may have adverse consequences for traumatic brain injury. The recent paper by Meier and colleagues suggests that intensive glycemic control may be deleterious. The present article explores existing literature surrounding this controversy and outlines the literature that raises concern. Finally I suggest an alternative course of action that may enable control of glucose in an optimal range. The treatment of traumatic brain injury centers on diligent intensive care and the prevention of secondary insults. One of the suspected secondary insults is early hyperglycemia. There is significant literature that associates early systemic hyperglycemia with poor neurological outcome after traumatic brain injury. The recent paper by Meier and colleagues raises new concerns about the control of hyperglycemia 1 . Hyperglycemia has repeatedly been associated with poor outcome after traumatic brain injury 2-5 with glucose values 300 mg dl mmol l uniformly associated with fatal traumatic brain injury in one study 3 . Continued hyperglycemia with glucose values 200 mg dl mmol l has been associated with poor outcome 4 . While intensivists are focused on preventing hyperglycemia and expend much clinical effort in achieving normoglycemia it remains unclear whether intensive glycemic control during .