[en] IntroductionTherapeutic hypothermia (TH) is often used to treat out of hospital cardiac arrest (OHCA) patients who also often simultaneously receive insulin for stress-induced hyperglycaemia. However, the impact of TH on systemic metabolism and insulin resistance in critical illness is unknown. This study analyses the impact of TH on metabolism, including the evolution of insulin sensitivity (SI) and its variability, in patients with coma after OHCA.MethodsThis study uses a clinically validated, model-based measure of SI. Insulin sensitivity was identified hourly using retrospective data from 200 post-cardiac arrest patients (8,522 hours) treated with TH, shortly after admission to the Intensive Care Unit (ICU). Blood glucose and body temperature readings were taken every one to two hours. Data were divided into three periods: 1) cool (T <35 degrees C); 2) an idle period of two hours as normothermia was re-established; and 3) warm (T >37 degrees C). A maximum of 24 hours each for the cool and warm periods were considered. The impact of each condition on SI is analysed per cohort and per patient for both level and hour-to-hour variability, between periods and in 6-hour blocks.ResultsCohort and per patient median SI levels increase consistently by 35% to 70% and 26% to 59% (P <0.001) respectively from cool to warm. Conversely, cohort and per patient SI variability decreased by 11.1% to 33.6% (P <0.001) for the first 12 hours of treatment. However, SI variability increases between the 18th and 30th hours over the cool-warm transition, before continuing to decrease afterward.ConclusionsOCHA patients treated with TH have significantly lower and more variable SI during the cool period, compared to the later warm period. As treatment continues, SI level rises, and variability decreases consistently except for a large, significant increase during the cool-warm transition. These results demonstrate increased resistance to insulin during mild induced hypothermia. Our study might have important implications for glycaemic control during targeted temperature management.
Penning, Sophie ; Université de Liège - ULiège > HEC-Ecole de gestion : UER > Diagnostic et contrôle de l'entreprise
Desaive, Thomas ; Université de Liège - ULiège > Département d'astrophys., géophysique et océanographie (AGO) > Thermodynamique des phénomènes irréversibles
Language :
English
Title :
Evolution of insulin sensitivity and its variability in out of hospital cardiac arrest (OHCA) patients treated with hypothermia.
scite shows how a scientific paper has been cited by providing the context of the citation, a classification describing whether it supports, mentions, or contrasts the cited claim, and a label indicating in which section the citation was made.
Bibliography
Capes, S.E., Hunt, D., Malmberg, K., Gerstein, H.C., Stress hyperglycaemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview (2000) Lancet, 355, pp. 773-778
McCowen, K.C., Malhotra, A., Bistrian, B.R., Stress-induced hyperglycemia (2001) Crit Care Clin, 17, pp. 107-124
Mizock, B.A., Alterations in fuel metabolism in critical illness: hyperglycaemia (2001) Best Pract Res Clin Endocrinol Metab, 15, pp. 533-551
van den Berghe, G., Wouters, P., Weekers, F., Verwaest, C., Bruyninckx, F., Schetz, M., Vlasselaers, D., Bouillon, R., Intensive insulin therapy in critically ill patients (2001) N Engl J Med, 345, pp. 1359-1367
Krinsley, J.S., Association between hyperglycemia and increased hospital mortality in a heterogeneous population of critically ill patients (2003) Mayo Clin Proc, 78, pp. 1471-1478
Krinsley, J.S., Effect of an intensive glucose management protocol on the mortality of critically ill adult patients (2004) Mayo Clin Proc, 79, pp. 992-1000
Chase, J.G., Shaw, G., Le Compte, A., Lonergan, T., Willacy, M., Wong, X.W., Lin, J., Hann, C., Implementation and evaluation of the SPRINT protocol for tight glycaemic control in critically ill patients: a clinical practice change (2008) Crit Care, 12, p. R49
Brunkhorst, F.M., Engel, C., Bloos, F., Meier-Hellmann, A., Ragaller, M., Weiler, N., Moerer, O., German Competence, S., Network Intensive insulin therapy and pentastarch resuscitation in severe sepsis (2008) N Engl J Med, 358, pp. 125-139
Finfer, S., Chittock, D.R., Su, S.Y., Blair, D., Foster, D., Dhingra, V., Bellomo, R., Ronco, J.J., Intensive versus conventional glucose control in critically ill patients (2009) N Engl J Med, 360, pp. 1283-1297
Preiser, J.C., Devos, P., Ruiz-Santana, S., Melot, C., Annane, D., Groeneveld, J., Iapichino, G., Chiolero, R., A prospective randomised multi-centre controlled trial on tight glucose control by intensive insulin therapy in adult intensive care units: the Glucontrol study (2009) Intensive Care Med, 35, pp. 1738-1748
Chase, J.G., Le Compte, A.J., Suhaimi, F., Shaw, G.M., Lynn, A., Lin, J., Pretty, C.G., Desaive, T., Tight glycemic control in critical care-the leading role of insulin sensitivity and patient variability: a review and model-based analysis (2011) Comput Methods Programs Biomed, 102, pp. 156-171
Taylor, N.A., Griffiths, R.F., Cotter, J.D., Epidemiology of hypothermia: fatalities and hospitalisations in New Zealand (1994) Aust N Z J Med, 24, pp. 705-710
Neumar, R.W., Nolan, J.P., Adrie, C., Aibiki, M., Berg, R.A., Bottiger, B.W., Callaway, C., Vanden Hoek, T., (2008) Circulation, 118, pp. 2452-2483. , Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A consensus statement from the International Liaison Committee on Resuscitation (American Heart Association, Australian and New Zealand Council on Resuscitation, European Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Asia, and the Resuscitation Council of Southern Africa) the American Heart Association Emergency Cardiovascular Care Committee the Council on Cardiovascular Surgery and Anesthesia the Council on Cardiopulmonary, Perioperative, and Critical Care
the Council on Clinical Cardiology and the Stroke Council
Pretty, C.G., Le Compte, A.J., Chase, J.G., Shaw, G.M., Preiser, J.C., Penning, S., Desaive, T., Variability of insulin sensitivity during the first 4 days of critical illness: implications for tight glycemic control (2012) Ann Intensive Care, 2, p. 17
Eisenburger, P., Sterz, F., Holzer, M., Zeiner, A., Scheinecker, W., Havel, C., Losert, H., Therapeutic hypothermia after cardiac arrest (2001) Curr Opin Crit Care, 7, pp. 184-188
Lee, R., Asare, K., Therapeutic hypothermia for out-of-hospital cardiac arrest (2010) Am J Health Syst Pharm, 67, pp. 1229-1237
Cueni-Villoz, N., Devigili, A., Delodder, F., Cianferoni, S., Feihl, F., Rossetti, A.O., Eggimann, P., Oddo, M., Increased blood glucose variability during therapeutic hypothermia and outcome after cardiac arrest (2011) Crit Care Med, 39, pp. 2225-2231
Hayashi, N., Management of pitfalls for the successful clinical use of hypothermia treatment (2009) J Neurotrauma, 26, pp. 445-453
Chase, J.G., Suhaimi, F., Penning, S., Preiser, J.C., Le Compte, A.J., Lin, J., Pretty, C.G., Desaive, T., Validation of a model-based virtual trials method for tight glycemic control in intensive care (2010) Biomed Eng Online, 9, p. 84
Evans, A., Shaw, G.M., Le Compte, A., Tan, C.S., Ward, L., Steel, J., Pretty, C.G., Chase, J.G., Pilot proof of concept clinical trials of Stochastic Targeted (STAR) glycemic control (2011) Ann Intensive Care, 1, p. 38
Lin, J., Razak, N.N., Pretty, C.G., Le Compte, A., Docherty, P., Parente, J.D., Shaw, G.M., Geoffrey Chase, J., A physiological Intensive Control Insulin-Nutrition-Glucose (ICING) model validated in critically ill patients (2011) Comput Methods Programs Biomed, 102, pp. 192-205
McAuley, K.A., Berkeley, J.E., Docherty, P.D., Lotz, T.F., Te Morenga, L.A., Shaw, G.M., Williams, S.M., Mann, J.I., The dynamic insulin sensitivity and secretion test-a novel measure of insulin sensitivity (2011) Metabolism, 60, pp. 1748-1756
Fisk, L.M., Le Compte, A.J., Shaw, G.M., Penning, S., Desaive, T., Chase, J.G., STAR development and protocol comparison (2012) IEEE Trans Biomed Eng, 59, pp. 3357-3364
Pretty, C.G., Signal, M., Fisk, L., Penning, S., Le Compte, A., Shaw, G.M., Desaive, T., Chase, J.G., Impact of sensor and measurement timing errors on model-based insulin sensitivity (2014) Comput Methods Programs Biomed, 114, pp. e79-e86
Hann, C.E., Chase, J.G., Lin, J., Lotz, T., Doran, C.V., Shaw, G.M., Integral-based parameter identification for long-term dynamic verification of a glucoseinsulin system model (2005) Comput Methods Programs Biomed, 77, pp. 259-270
Bagshaw, S.M., Egi, M., George, C., Bellomo, R., Australia New Zealand Intensive Care Society Database Management C: Early blood glucose control and mortality in critically ill patients in Australia (2009) Crit Care Med, 37, pp. 463-470
Langouche, L., Vander Perre, S., Wouters, P.J., D'Hoore, A., Hansen, T.K., Van den Berghe, G., Effect of intensive insulin therapy on insulin sensitivity in the critically ill (2007) J Clin Endocrinol Metab, 92, pp. 3890-3897
Sechterberger, M.K., Bosman, R.J., Oudemans-van Straaten, H.M., Siegelaar, S.E., Hermanides, J., Hoekstra, J.B., De Vries, J.H., The effect of diabetes mellitus on the association between measures of glycaemic control and ICU mortality: a retrospective cohort study (2013) Crit Care, 17, p. R52
Bartnik, M., Ryden, L., Ferrari, R., Malmberg, K., Pyorala, K., Simoons, M., Standl, E., Euro Heart Survey, I., The prevalence of abnormal glucose regulation in patients with coronary artery disease across Europe The Euro Heart Survey on diabetes and the heart (2004) Eur Heart J, 25, pp. 1880-1890
This website uses cookies to improve user experience. Read more
Save & Close
Accept all
Decline all
Show detailsHide details
Cookie declaration
About cookies
Strictly necessary
Performance
Strictly necessary cookies allow core website functionality such as user login and account management. The website cannot be used properly without strictly necessary cookies.
This cookie is used by Cookie-Script.com service to remember visitor cookie consent preferences. It is necessary for Cookie-Script.com cookie banner to work properly.
Performance cookies are used to see how visitors use the website, eg. analytics cookies. Those cookies cannot be used to directly identify a certain visitor.
Used to store the attribution information, the referrer initially used to visit the website
Cookies are small text files that are placed on your computer by websites that you visit. Websites use cookies to help users navigate efficiently and perform certain functions. Cookies that are required for the website to operate properly are allowed to be set without your permission. All other cookies need to be approved before they can be set in the browser.
You can change your consent to cookie usage at any time on our Privacy Policy page.