Details

Autor(en) / Beteiligte

• van Iersel, Freya M.
• Slooter, Arjen J. C.
• Vroegop, Renee
• Wolters, Annemiek E.
• Tiemessen, Charlotte A. M.
• Rösken, Rik H. J.
• van der Hoeven, Johannes G.
• Peelen, Linda M.
• Hoedemaekers, Cornelia W. E.

Titel

Risk factors for hypoglycaemia in neurocritical care patients

Ist Teil von

• Intensive care medicine, 2012-12, Vol.38 (12), p.1999-2006

Ort / Verlag

Berlin/Heidelberg: Springer-Verlag

Erscheinungsjahr

2012

Link zum Volltext

Quelle

MEDLINE

Beschreibungen/Notizen

• Purpose To identify risk factors for hypoglycaemia in neurocritical care patients receiving intensive insulin therapy (IIT). Methods We performed a nested case–control study. All first episodes of hypoglycaemia (glucose <80 mg/dL, <4.4 mmol/L) in neurocritical care patients between 1 March 2006 and 31 December 2007 were identified. Patients were treated according to the local IIT protocol, with target blood glucose levels between 4.5 and 6.0 mmol/L (81.0–108.0 mg/dL). The first hypoglycaemic event of every patient (index moment) was used to match to a control patient. Possible risk factors preceding the index moment were scored using hospital records and analysed with conditional logistic regression. Results Of 786 neurocritical care patients, 449 developed hypoglycaemia (57.1 %). Independent risk factors for hypoglycaemia were lowering nutrition 6 h before the index moment without insulin dose reduction (odds ratio (OR) 5.25, 95 % confidence interval (95 % CI) 1.32–20.88), mechanical ventilation (OR 2.59, 95 % CI 1.56–4.29), lowering the dosage of norepinephrine 3 h before the index moment (OR 2.44, 95 % CI 1.07–5.55), a hyperglycaemic event (>10 mmol/L, >180.0 mg/dL) in the 24 h preceding the index moment (OR 2.40, 95 % CI 1.26–4.58), gastric residual in the 6 h preceding the index moment without insulin dose reduction (OR 1.76, 95 % CI 1.05–2.96) and dosage of insulin at the index moment (OR 0.83, 95 % CI 0.76–0.90). Conclusion Hypoglycaemia occurs in a considerable proportion of neurocritical care patients. We recommend the identification of these risk factors in these patients to avoid the occurrence of hypoglycaemia.