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The impact of admission hyperglycemia or hypoalbuminemia on need ventilator, time ventilated, mortality, and morbidity in critically ill trauma patients

Mohammadreza Safavi, Azim Honarmand
Turkish Journal of Trauma & Emergency Surgery: TJTES 2009, 15 (2): 120-9
19353313

BACKGROUND: The aim of this study was to evaluate the value of hypoalbuminemia or hyperglycemia as predictors for need ventilator and for weaning success in critically ill trauma patients.

METHODS: A single center, retrospective trial was done on 600 trauma patients = or >16 years old admitted for three or more days to the intensive care unit. Patients were classified into five different groups according to the reason for respiratory failure. The subsequent parameters were noted: serum albumin and glucose concentration, Acute Physiology and Chronic Health Evaluation III score, need ventilator, ventilator days, and fluid balance.

RESULTS: The initial mean serum glucose concentration was 9.3 (167.4) +/- 0.2 (3.6 mg/dl) mmol/L and the initial mean serum albumin concentration was 30.2 (3.02) +/- 0.02 (0.2 g/dl) g/L. Even though the circulating albumin concentration was considerably lower and serum glucose concentration was significantly higher in ICU nonsurvivors than in ICU survivors, neither albumin (r=-0.031, p=0.23) nor blood glucose concentration (r=0.050, p=0.11) on ICU admission was a predictor of the duration of mechanical ventilation. The profile of albumin and glucose concentration changes was dissimilar between weaned and mechanical ventilation-dependent patients. An increase of 5 g/L (0.5 g/dl) in serum albumin concentration multiplied the relative success probability by 1.10. Patients with serum albumin concentration less than 30.3 (3.03 g/dl) g/L were 1.2 times more likely to need ventilator than normo-albuminemic patients (relative risk 1.2, 95% confidence interval 1.06-1.31). The risk of need mechanical ventilation did not increase with blood glucose concentration more than 11 mmol/L (200 mg/dl).

CONCLUSION: These results suggest that albumin and blood glucose are possible indexes of the metabolic status of the trauma patient, which could be essential in deciding the need ventilator and weanable status of the patients who are mechanically ventilated for extended periods of time.

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