Intensive Insulin Therapy after Decompression Surgery for Severe Traumatic Brain Injury

Abstract

Following acute traumatic brain injury, stress induced catecholamine release can result in elevated blood glucose levels. Hyperglycemia has been considered a stress response and a simple reflection of the injury severity. In animal studies of ischemic and hemorrhagic stroke, hyperglycemia has been associated with increased ischemic brain damage, edema, and peri-lesional cell death. Early hyperglycemia in rats with traumatic brain injury (TBI) was associated with a larger contusion area and increased inflammation. Current guidelines for acute ischemic stroke suggest that interventions are indicated if a glucose level is greater than 180 mg/dL. Since a landmark trial which demonstrated a significant decrease in mortality using intensive insulin protocol targeting blood glucose levels between 80 and 110 mg/dL in surgical intensive care patients, tight glucose control has been widely adopted in the critical setting. Traditionally, the authors have collaborated with endocrinologists for the control of hyperglycemia in neurosurgical intensive care unit (NSICU), especially in cases with more than 200 mg/dL of blood glucose level. The different treatments affect the clinical outcomes of patients with severe TBI. Therefore, we focus on the craniectomy, a uniform surgical intervention that is widely performed and useful for the treatment of TBI. Here, we have evaluated the feasibility of intensive insulin therapy for patients with severe TBI who underwent decompressive craniectomy. Received: February 14, 2012 / Revised: March 9, 2012 Accepted: March 10, 2012 Address for correspondence: Seung-Ho Yang, MD Department of Neurosurgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, 93 Jungbu-daero, Paldal-gu, Suwon 442-723, Korea Tel: +82-31-249-8304, Fax: +82-31-245-5208 E-mail: 72ysh@catholic.ac.kr