INSULIN RESISTANCE AND SIRS

Introduction and aim: Systemic Inflammatory Response Syndrome (SIRS) is common complication in neurosurgical diseases in Intensive Care Unit. Furthermore, due to these complications many reports show insulin resistance and specially the Intensive Care is in dilemma in which stage to start the nutrition to patients and what is the amount of Insulin Unit to control the hyperglycemia. Methods. 200 patients with neurosurgical disease with SIRS complications were treated in neurosurgical intensive care unit. All patients were randomized in two groups divided in early nutrition 94 patients (47%) and late nutrition 106 (53%) compared each other for several variables. The data included age, gender, length of stay, white blood account, glycemia was measured every hour, amount of insulin used per patients measured as units per day, SIRS complications, Body Mass Index, body temperature, cardiac and respiratory frequencies, blood pressure. Blood, urine and cerebro- spinal liquor and bronchial secretions bacteriological examinations. Results: No statistical difference in age and gender in two groups(P0.05) The amount of insulin units to control the level of glycemia (80-110 mg/dc) was 12.8±7 unit per day in early nutrition and 23.8 ±12.9 units in late nutrition (p0.01). No patient in early nutrition group developed insulin resistance. Among the patients of late nutrition group 6 (7.4%) patients developed insulin resistance. (p=0.03). Conclusion: the insulin resistance due to the infection complications is higher among late nutrition than early nutrition group. Recommendation: we think that in neurosurgical ICU is better to start the nutrition within 72 hours.