Pilot Mechanistic Study of Insulin Modulation of Somatotrophic Hormones, Inflammation, and Lipid Metabolism During Critical Illness in Children*
| Autor: | Robert C. Tasker, Pedro Celiny Ramos Garcia, Jefferson Pedro Piva, Humberto Holmer Fiori, Felipe Cezar Cabral, Matteo Baldisserotto, Geniara S. Conrado, Cecilia Korb, Ricardo Garcia Branco |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Adolescent Critical Illness medicine.medical_treatment Pilot Projects Inflammation 030204 cardiovascular system & hematology Critical Care and Intensive Care Medicine Proinflammatory cytokine 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Humans Hypoglycemic Agents Insulin 030212 general & internal medicine Insulin-Like Growth Factor I Child Infusions Intravenous Human Growth Hormone business.industry Growth factor Infant Newborn Infant Lipid metabolism Lipid Metabolism Somatotrophs Insulin-Like Growth Factor Binding Protein 1 Insulin-Like Growth Factor Binding Protein 3 Endocrinology Child Preschool Pediatrics Perinatology and Child Health Glucose Clamp Technique Cytokines Female Tumor necrosis factor alpha medicine.symptom business Biomarkers Lipoprotein Hormone |
| Zdroj: | Pediatric Critical Care Medicine. 18:e35-e41 |
| ISSN: | 1529-7535 |
| DOI: | 10.1097/pcc.0000000000001011 |
| Popis: | OBJECTIVES To evaluate the mechanism of insulin modulation on somatotrophic response, inflammation, and lipid metabolism in critically ill children. DESIGN Open-label randomized mechanistic study. SETTING Two-center, tertiary PICU study. PATIENTS Thirty critically ill children between 1 month and 14 years old, requiring mechanical ventilation and with evidence of two or more organ system failures. INTERVENTIONS Randomized physiologic design of hyperinsulinemic-euglycemic clamp using continuous insulin infusion at 0.1 U/kg/hr versus conventional management. MEASUREMENTS AND MAIN RESULTS Thirteen children underwent hyperinsulinemic-euglycemic clamp. Blood samples for somatotrophic, inflammatory, and metabolic evaluation were obtained before randomization, and 24 and 72 hours later. A growth hormone oscillation profile was obtained during the first night. There was no difference between groups at baseline. Growth hormone resistance, increased proinflammatory cytokines, and increased lipolysis with low lipoprotein levels were present in all patients. Hyperinsulinemic-euglycemic clamp did not affect growth hormone, insulin-like growth factor-1 or insulin-like growth factor binding protein-3 levels. By day 2, insulin reduced insulin-like growth factor binding protein-1 levels. Tumor necrosis factor-α and interleukin-1β were similar in both groups, whereas interleukin-6 levels reduced over time only in children receiving hyperinsulinemic-euglycemic clamp. Hyperinsulinemic-euglycemic clamp also decreased free fatty acid levels, which was accompanied by increased low-density lipoprotein cholesterol and relative increase in high-density lipoprotein levels. Total cholesterol and triglycerides were unchanged. CONCLUSIONS Insulin does not reverse most of the somatotrophic changes induced by the stress of critical illness. Rather, it may improve lipid metabolism and down-regulate some markers of the inflammatory response. |
| Databáze: | OpenAIRE |
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