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Critical Care Research and Practice
Volume 2017 (2017), Article ID 4831480, 7 pages
https://doi.org/10.1155/2017/4831480
Research Article

Variability in Glycemic Control with Temperature Transitions during Therapeutic Hypothermia

1Division of Adult Medicine, Department of Pharmacy Practice, Texas Tech University Health Sciences Center School of Pharmacy, 1300 S. Coulter St., Room 206, Amarillo, TX 79106, USA
2Advanced ICU Care, Houston Office, 7505 S. Main St., Houston, TX 77030, USA

Correspondence should be addressed to Krystal K. Haase; ude.cshutt@esaah.latsyrk

Received 15 March 2017; Revised 3 July 2017; Accepted 9 August 2017; Published 18 September 2017

Academic Editor: Rao R. Ivatury

Copyright © 2017 Krystal K. Haase et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose. Patients treated with therapeutic hypothermia (TH) and continuous insulin may be at increased risk of hyperglycemia or hypoglycemia, particularly during temperature transitions. This study aimed to evaluate frequency of glucose excursions during each phase of TH and to characterize glycemic control patterns in relation to survival. Methods. Patients admitted to a tertiary care hospital for circulatory arrest and treated with both therapeutic hypothermia and protocol-based continuous insulin between January 2010 and June 2013 were included. Glucose measures, insulin, and temperatures were collected through 24 hours after rewarming. Results. 24 of 26 patients experienced glycemic excursions. Hyperglycemic excursions were more frequent during initiation versus remaining phases (36.3%, 4.3%, 2.5%, and 4.0%, ). Hypoglycemia occurred most often during rewarming (0%, 7.7%, 23.1%, and 3.8%, ). Patients who experienced hypoglycemia had higher insulin doses prior to rewarming (16.2 versus 2.1 units/hr, ). Glucose variation was highest during hypothermia and trended higher in nonsurvivors compared to survivors (13.38 versus 9.16, ). Frequency of excursions was also higher in nonsurvivors (32.3% versus 19.8%, ). Conclusions. Glycemic excursions are common and occur more often in nonsurvivors. Excursions differ by phase but risk of hypoglycemia is increased during rewarming.