Intensive Insulin Therapy in Severe Traumatic Brain Injury: A Randomized Trial

Background: Intensive insulin therapy (IIT) has been shown to reduce morbidity and mortality in critically ill patients. Little investigation has been done to find out whether it improves the prognosis of patients with severe traumatic brain injury (STBI). Methods: We conducted a prospective controlled study where adult patients with blunt STBI, with Glasgow Coma Scale <= 8, admitted to the intensive care unit (ICU) were randomly assigned to receive either IIT (maintenance of blood glucose between 80 mg/dL and 110 mg/dL with continuous insulin infusion) or conventional glycemic therapy (CGT) (maintenance of blood glucose below 180 mg/dL with subcutaneous insulin and insulin infusion only if blood glucose levels exceeded 220 mg/dL). The main outcome was Glasgow outcome scale 6 months after trauma. Secondary measures were hypoglycemia, incidence of infections, and days in ICU. Results: Of the 88 patients randomized, 42 were assigned to IIT and 46 to CGT. There was no difference (p = 0.63) in neurologic outcomes between the treatment groups: Glasgow outcome scale > 3 was observed in 16 patients (41%) in the IIT and in 13 patients (32.5%) in the CGT group. More patients in the IIT group had hypoglycemia: 32 (82.1%), compared with 7 (17.5%) in the CGT group (p < 0.001). There were no differences in the number of days spent in the ICU (18.2 +/- 27.6 vs. 12.9 +/- 12.7) or in the sepsis rates (84.6% vs. 80%) between the groups. Conclusion: In our study, IIT did not improve the neurologic outcome of patients with STBI but did increase the risk of hypoglycemia compared with CGT.