PMID- 24709494
OWN - NLM
STAT- MEDLINE
DCOM- 20150411
LR  - 20140408
IS  - 2095-4352 (Print)
VI  - 26
IP  - 4
DP  - 2014 Apr
TI  - [Clinical study of the influence of daily sedation interruption on fluctuation of 
      blood glucose level and mortality of critical patients with multiple trauma].
PG  - 233-8
LID - 10.3760/cma.j.issn.2095-4352.2014.04.007 [doi]
AB  - OBJECTIVE: To assess the influence of a protocol of routine daily interruption of 
      sedation on fluctuation of blood glucose level and mortality of critical patients 
      with multiple trauma. METHODS: A prospective study involving 68 critical patients 
      with multiple trauma admitted to intensive care unit (ICU) was performed. Finger 
      blood glucose level was measured after the implementation of daily interruption 
      of sedation, and the results were recorded every 2 hours during the first 24 
      hours. Mean (MEAN), standard deviation (SD) and coefficient of variability (CV) 
      of blood glucose level, glycemic liability index (GLI), mean amplitude of 
      glycemic excursion (MAGE) and largest amplitude of glycemic excursions (LAGE) 
      were calculated respectively, and 30-day mortality was recorded. The patients 
      under study were divided into four groups according to the median values of MEAN 
      and GLI, group A with patients of low MEAN+low GLI (n=34), group B with patients 
      of low MEAN+high GLI (n=14), group C with patients of high MEAN+low GLI (n=12), 
      and group D with patients of high MEAN+high GLI (n=8). Glucose levels, their 
      range of fluctuation, and the prognosis were compared among groups. RESULTS: Five 
      of the 68 patients died, with a gross mortality rate of 7.4%. Group analysis 
      demonstrated that the patients in group A had the best prognosis with the 30-day 
      mortality rate of 0 (0/34), while that of the group D was worst with the 30-day 
      mortality rate of 37.5% (3/8). The MEAN levels of glucose were relatively lower 
      in groups A and B (6.7+/-1.3 mmol/L, 7.6+/-0.8 mmol/L) and higher in groups C and D 
      (9.3+/-1.4 mmol/L, 10.7+/-1.3 mmol/L). Indicators of glucose level fluctuation, 
      including SD, CV, GLI, LAGE, and MAGE, were lower in groups A and C (SD: 1.6+/-0.4 
      mmol/L, 1.7+/-0.6 mmol/L; CV: 0.2+/-0.1, 0.2+/-0.1; GLI: 26.5+/-19.5, 40.1+/-17.6; LAGE: 
      4.6+/-2.3 mmol/L, 6.5+/-1.9 mmol/L; MAGE: 2.7+/-0.8 mmol/L, 3.1+/-0.80 mmol/L), and 
      higher in groups B and D (SD: 2.9+/-0.7 mmol/L, 3.9+/-0.8 mmol/L; CV: 0.4+/-0.1, 
      0.4+/-0.1; GLI: 120.5+/-33.2, 184.6+/-98.4; LAGE: 9.5+/-2.0 mmol/L, 12.7+/-4.0 mmol/L; 
      MAGE: 6.2+/-1.2 mmol/L, 7.6+/-1.8 mmol/L). The incidence of hypoglycemia was highest 
      in group D [5.8% (6/104)], followed by that of group B [1.6% (3/182)], while that 
      of groups A and C was lower [0.9% (4/442), 0.1% (2/256)]. The incidence of 
      hyperglycemia were highest in groups C and D [67.3% (105/156), 69.2% (72/104)], 
      and it was followed by that of group B [33.5% (61/182)], and that of group A was 
      the lowest [15.4% (68/442)]. The duration of mechanical ventilation [(3.4+/-3.3) 
      days], the incidence of multiple organ failure (MOF, 44.1%, 15/34), rate of 
      continuous renal replacement therapy (CRRT, 11.8%, 4/34), and day in ICU 
      [(5.1+/-3.9) days] were shortest and lowest in group A, and highest and longest in 
      group D [(9.4+/-5.2) days, 87.5% (7/8), 75.0% (4/8), (10.3+/-7.4) days]. CONCLUSIONS: 
      Daily interruption of sedation can reduce fluctuation of blood glucose level in 
      critical patients with multiple trauma, and improve patients' outcome.
FAU - Li, Yong
AU  - Li Y
AD  - Department of Critical Care Medicine, Affiliated People's Hospital of Jiangsu 
      University, Zhenjiang 212002, Jiangsu, China. Corresponding author: Jin Zhaochen, 
      Email: jinzc57@yahoo.com.cn.
FAU - Jin, Zhaochen
AU  - Jin Z
FAU - Cai, Yan
AU  - Cai Y
FAU - Ji, Musen
AU  - Ji M
FAU - Kong, Xianru
AU  - Kong X
FAU - Liu, Jing
AU  - Liu J
FAU - Yang, Hongfeng
AU  - Yang H
FAU - Wang, Chenglong
AU  - Wang C
LA  - chi
PT  - Comparative Study
PT  - English Abstract
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - China
TA  - Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
JT  - Zhonghua wei zhong bing ji jiu yi xue
JID - 101604552
RN  - 0 (Blood Glucose)
SB  - IM
MH  - Adult
MH  - Blood Glucose/*analysis
MH  - Conscious Sedation/*methods
MH  - Female
MH  - Hospital Mortality
MH  - Humans
MH  - Intensive Care Units
MH  - Male
MH  - Middle Aged
MH  - Multiple Trauma/*blood/*mortality
MH  - Prognosis
MH  - Prospective Studies
EDAT- 2014/04/09 06:00
MHDA- 2015/04/12 06:00
CRDT- 2014/04/09 06:00
PHST- 2014/04/09 06:00 [entrez]
PHST- 2014/04/09 06:00 [pubmed]
PHST- 2015/04/12 06:00 [medline]
AID - 10.3760/cma.j.issn.2095-4352.2014.04.007 [doi]
PST - ppublish
SO  - Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2014 Apr;26(4):233-8. doi: 
      10.3760/cma.j.issn.2095-4352.2014.04.007.