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Objectives:

To analyze the effect of tight glycemic control with the use of intensive insulin therapy on cerebral glucose metabolism in patients with severe brain injury.

Design:

Retrospective analysis of a prospective observational cohort.

Setting:

University hospital neurologic intensive care unit.

Patients:

Twenty patients (median age 59 yrs) monitored with cerebral microdialysis as part of their clinical care.

Interventions:

Intensive insulin therapy (systemic glucose target: 4.4–6.7 mmol/L [80–120 mg/dL]).

Measurements and Main Results:

Brain tissue markers of glucose metabolism (cerebral microdialysis glucose and lactate/pyruvate ratio) and systemic glucose were collected hourly. Systemic glucose levels were categorized as within the target “tight”(4.4–6.7 mmol/L [80–120 mg/dL]) vs.“intermediate”(6.8–10.0 mmol/L [121–180 mg/dL]) range. Brain energy crisis was defined as a cerebral microdialysis glucose< 0.7 mmol/L …