Post on 12-Jan-2016
RELATIONSHIP BETWEEN HYPERGLYCEMIA AND OUTCOME IN
CHILDREN WITH SEVERE TRAUMATIC BRAIN INJURY
Written by: Rebecca L. Smith, John C. Lin, David Adelson, Patrick M. Kochanek, Erica L. Fink, Stephen R. Wisniewski, Huelya Bayir, Elizabeth C. Tyler-Kabra, Robert S. B. Clark, S. Danielle Brown,
Michael J. Bell
Presented by: Lucan Sanchez
Introduction
Over 300,000 concussions are diagnosed, in athletes, annually
50,000 deaths a year due to TBI’s
2% of the US’ population lives with neurological disabilities resulting from TBI’s
Nuerometabolic Cascade of Concussion
The series of steps that follow a TBI in the brain
1. Calcium and Potassium ion imbalance in the brain
2. Ion pumps work overtime in order to restore balance, require large amounts of glucose
3. Impaired blood flow to brain limits amount of glucose available, massive energy crisis
4. Brain begins anaerobic respiration, produces lactic acid which further damages the brain
Hyperglycemia
An excess of glucose in the brain
Why is it bad?
No definitive answer yet, all scientists have are theories
One theory is that the excess glucose in the brain produces oxygen free radicals that then attack the brain cells
Key Terms
Traumatic Brain Injury(TBI)- any impact to the head that can cause physical damage and long-term complications
Dextrose- a simple plant based monosaccharide used as a fluid and nutrient replenisher
Hypoglycemia- a shortage of glucose in the brain
Key Terms Cont.
Glasgow Coma Score- A scale from 3-15 that measures the severity of the TBI
Lactate- the lactic acid production by the brain during anaerobic respiration
NG, MHG, SHG
Review of Literature
Yung M, Wilkins B, Norton L, et al; Glucose control, organ failure, and mortality in pediatric intensive care Pediatr Crit Care Med 2008; 9:147-152
Hirshberg E, Larsen G, Van Duker H: Alterations in glucose homeostasis in the pediatric intensive care unit: Hyperglycemia and glucose variability are associated with increased mortality and morbidity Pediatr Crit Care Med 2008; 9:361-366
Review of Literature
Michaud LJ, Rivara FP, Longstreth WT Jr, et al: Elevated initial blood glucose levels and poor outcome following severe brain injuries in children. J Trauma 1991; 31:1356-1362
Hypothesis
To determine the relationship between hyperglycemia and outcome in infants and children after severe TBI
Methods and Materials
All Children admitted with a TBI and Glasgow Coma score <8 were eligible for the study
A subset of these kids were also enrolled in a trial in which they tested hypothermia as a nueroprotectant
Methods and Materials
Glucose administration avoided for 48 hours post-TBI
Glucose timing and insulin administration was at discretion of team
48 hours post injury 5% dextrose IV drip
Results
Early Late105
110
115
120
125
130
135
140
FavorableUnfavorable
Results
Early NG
Late NG 64% Late MHG 18% Late SHG 18%
Early MHG
Late NG 46% Late MHG 27% Late SHG 27%
Early SHG
Late NG 26% Late MHG 40% Late SHG 34%
Discussion/Conclusion
Insulin administration was a potential source of error
Hypothermia and the re-warming process could have skewed results
More regulated glucose administration after 48 hours may yield different results
Discussion/Conclusion
Hyperglycemia beyond 48 hours(Delayed hyperglycemia) post-injury results in poor outcome
This study found no association between early hyperglycemia and outcome
More research must be done in order to discover the optimal approach to treating kids with a TBI
Acknowledgments
Ms. Gleason My family Fellow Science Research Students
Questions??