ArticleCritical care (London, England)2012
Nutritional support and brain tissue glucose metabolism in poor-grade SAH: a retrospective observational study.
Article in Critical care (London, England), 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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Who cites it
13 citing papers in PubMed, 26 citations in OpenAlex.
- Liberalization of the Systemic Glucose Management is Associated with a Reduced Frequency of Neuroglucopenia in Subarachnoid Hemorrhage Patients: An Observational Cohort Study.Neurocritical care · 2025Observational
- High-physiological and supra-physiological 1,2-Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism · 2023Article
- Optimization of Nutrition after Brain Injury: Mechanistic and Therapeutic Considerations.Biomedicines · 2023Review
- Controlling nutritional status score during hospitalization as a predictor of clinical outcome in patients with aneurysmal subarachnoid hemorrhage.Scientific reports · 2023Observational
- Observational
- Neurocritical care management of poor-grade subarachnoid hemorrhage: Unjustified nihilism to reasonable optimism.The neuroradiology journal · 2021Review
- Nutrition Therapy, Glucose Control, and Brain Metabolism in Traumatic Brain Injury: A Multimodal Monitoring Approach.Frontiers in neuroscience · 2020Review
- Enteral nutrition increases interstitial brain glucose levels in poor-grade subarachnoid hemorrhage patients.Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism · 2018Observational
- Clinical Use of Cerebral Microdialysis in Patients with Aneurysmal Subarachnoid Hemorrhage-State of the Art.Frontiers in neurology · 2017Review
- Neuroglucopenia and Metabolic Distress in Two Patients with Viral Meningoencephalitis: A Microdialysis Study.Neurocritical care · 2016Article
- Consensus statement from the 2014 International Microdialysis Forum.Intensive care medicine · 2015Article
- Glucose and the injured brain-monitored in the neurointensive care unit.Frontiers in neurology · 2014Review
- Population physiology: leveraging electronic health record data to understand human endocrine dynamics.PloS one · 2012Article
Corrections and comments
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Authors and funding
10 authors at 4 institutions in 1 country.
Funding
Abstract
introductionWe sought to determine the effect of nutritional support and insulin infusion therapy on serum and brain glucose levels and cerebral metabolic crisis after aneurysmal subarachnoid hemorrhage (SAH).
methodsWe used a retrospective observational cohort study of 50 mechanically ventilated poor-grade (Hunt-Hess 4 or 5) aneurysmal SAH patients who underwent brain microdialysis monitoring for an average of 109 hours. Enteral nutrition was started within 72 hours of admission whenever feasible. Intensive insulin therapy was used to maintain serum glucose levels between 5.5 and 7.8 mmol/l. Serum glucose, insulin and caloric intake from enteral tube feeds, dextrose and propofol were recorded hourly. Cerebral metabolic distress was defined as a lactate to pyruvate ratio (LPR)>40. Time-series data were analyzed using a general linear model extended by generalized estimation equations (GEE).
resultsDaily mean caloric intake received was 13.8±6.9 cal/kg and mean serum glucose was 7.9±1 mmol/l. A total of 32% of hourly recordings indicated a state of metabolic distress and <1% indicated a state of critical brain hypoglycemia (<0.2 mmol/l). Calories received from enteral tube feeds were associated with higher serum glucose concentrations (Wald=6.07, P=0.048), more insulin administered (Wald=108, P<0.001), higher body mass index (Wald=213.47, P<0.001), and lower body temperature (Wald=4.1, P=0.043). Enteral feeding (Wald=1.743, P=0.418) was not related to brain glucose concentrations after accounting for serum glucose concentrations (Wald=67.41, P<0.001). In the presence of metabolic distress, increased insulin administration was associated with a relative reduction of interstitial brain glucose concentrations (Wald=8.26, P=0.017), independent of serum glucose levels.
conclusionsIn the presence of metabolic distress, insulin administration is associated with reductions in brain glucose concentration that are independent of serum glucose levels. Further study is needed to understand how nutritional support and insulin administration can be optimized to minimize secondary injury after subarachnoid hemorrhage.
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