An effective insulin infusion protocol for severe traumatic brain injury patients: A retrospective observational study

Abstract

Purpose

Severe traumatic brain injury (sTBI) patients often experience stress hyperglycaemia, which can lead to negative outcomes. This study aims to introduce an effective insulin infusion protocol specifically designed for sTBI patients.

Methods

Data was collected from all sTBI patients during two periods: 1 October 2019 to 30 April 2020, and 1 June 2020 to 31 December 2020. In May 2020, a new insulin infusion protocol was implemented. Blood glucose management, infection, coagulation, and prognosis were compared in these two periods.

Result

195 patients were included, with 106 using the new protocol. The proportion of hyperglycaemia decreased from 40.04% to 26.91% (P < 0.05), and the proportion of on-target blood glucose levels increased from 35.69% to 38.98% (P < 0.05). Average blood glucose levels decreased from 9.98 ± 2.79 mmol/L to 8.96 ± 2.82 mmol/L (P < 0.05). There was no substantial increase in hypoglycaemia, which remained controlled below 1%. The new protocol positively influenced glucose concentration and dispersion trends. There were no significant differences in catheter-related infections, antibiotic use, mechanical ventilation (MV) duration, length of stay in ICU, Glasgow Outcome Scale (GOS), or mortality. However, the conventional protocol group had a higher coagulation tendency (R-value of thromboelastography 4.80 ± 1.35 min vs. 5.52 ± 1.87 min, P < 0.05), with no difference in deep vein thrombosis (DVT) incidence.

Conclusion

Our findings suggest that a customized insulin infusion process for sTBI patients can effectively manage blood glucose. While there is no significant improvement in infection control or prognosis, it may have a positive impact on coagulation without affecting the occurrence of DVT.