Stress-induced Hyperglycemia: Is It Harmful Following Trauma?

Section of Trauma, Burns, and Surgical Critical Care, Department of Surgery, The University of Alabama at Birmingham, LHRB 112, 701 19th Street South, Birmingham, AL 35294-0007, USA.
Advances in Surgery 09/2013; 47(1):287-97. DOI: 10.1016/j.yasu.2013.03.002
Source: PubMed


There is an established association between the presence of SIH and worse morbidity and mortality after trauma. However, given the limitations of existing data, no definitive statements can be made as to whether aggressive treatment of hyperglycemia actually benefits outcome. Although early studies seemed to show a clear benefit in surgical ICU patients, subsequent studies have not duplicated these results. In addition, severe hypoglycemic episodes associated with glycemic control protocols have provided further concern, because they have been associated with higher rates of mortality. These disparate outcomes in prospective, randomized trials have not allowed definitive conclusions to be drawn regarding the exact glucose levels that should be maintained. Regardless, some postinjury control of glucose levels is likely necessary. Without data to support the practice, tight glycemic control keeping glucose levels below 110 mg/dL is likely not necessary and probably detrimental to patient outcome. It seems that a more moderate level of glycemic control, aimed at providing stabilization of glucose levels while reducing hyperglycemic and hypoglycemic events, is being practiced in most institutions. Performance of prospective, randomized trials in the trauma population along with further advancement and refinement of techniques to more precisely reduce glucose variability will further clarify the level of glucose control associated with improved outcomes.

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    • "Our experiment showed that, blood glucose levels were elevated in 0.5 h after injection of LPS, and there was statistically significant effect on half-hourly blood glucose between LPS group and control group from 0.5 h to 2 h. In fact, physical trauma, surgical-site infection, and many forms of severe stress can temporarily increase glucose levels [32–34]. Even only hypothermia can have the “perverse result.” "
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