[ impact of hyperglycemia or hypoalbuminemia on duration and need to mechanical ventilation in critically ill patients]

ABSTRACT

In addition to lung mechanics measurements, many physiological factors also have impact on weaning of critically ill patients, but are often overlooked. Hyperglycemia is common in critically ill patients. The purpose of this study was to assess the utility of hypoalbuminaemia or hyperglycemia as predictors for need ventilator and weaning success in critically ill patients. A single center, descriptive- analytical trial was done on 600 patient's >= 16 years old admitted for 3 or more days to intensive care unit. Patients were classified into five different groups based on the cause of respiratory failure. The following parameters were recorded serum albumin and glucose concentration; Acute Physiology and Chronic Health Evaluation III score; need ventilator, ventilation days, and fluid balance. The initial mean serum glucose concentration was 9.3 +/- 0.2 mmol/l and the initial mean serum albumin concentration was 30.2 +/- 0.02 [0.2 g/dl] g/l. Although the circulating albumin concentration was significantly lower and serum glucose concentration was significantly higher in ICU nonsurvivors than in ICU survivors, albumin [r=-0.031, P>0.05] and blood glucose concentration [r=0.050, P>0.01] on ICU admission were not a predictor of the length of time spent receiving mechanical ventilation. Patients with serum albumin concentration less than 30.3 [3.03 g/dl] g/l were one and two tenth times more likely to need ventilator than normoalbuminemic patients [relative risk 1.2, 95% confidence interval 1.06 to 1.31]. The risk of need to mechanical ventilation did not raise with blood glucose concentration more than 11 mmol/l [200 mg/dl]. These findings suggest that albumin or blood glucose may be an index of the metabolic status of the patient, which could be important in determining the need ventilator and wean ability of the patients who are mechanically ventilated for prolonged periods of time