Glycemic Management After Resuscitation: Is Glucose The Best Alternative?

Context: Hyperglycemia after resuscitation in both critically-ill adults and preterm newborns is associated with increased mortality and poor brain outcome. Lactose, composed of 50% glucose and 50% galactose is the unique means Nature offers to the newborn, who in absence of modern care suffers from severe bioenergetic impairment, similarly to adults resuscitated after cardiac arrest. Aim of this study is to review these issues, to understand how we may improve outcomes in intensive care units.
Evidence Acquisition: A review study was conducted in 2017 through searching on Science Direct, PubMed, Wiley, and Blackwell databases. The search was performed using bioenergetics, cardiac arrest, critical illness, hyperglycemia, glucose, galactose, newborn and resuscitation, as key words. Finally, 24 articles in English were assessed in this study, thereby comprised 2 guidelines (2015 American heart association and guidelines for both Adult and Neonatal Resuscitation.
Correct glycemic control strategy in extreme ATP deficit conditions, such as after resuscitation from a cardiac arrest or a complicated or preterm birth can improve outcome. 2015 American heart association (AHA) guidelines do not recommend glucose infusion after cardiac arrest. Data on glucose administration following brain insult in newborn are limited. Outcomes of applying the hypothesis allowed to assess that glucose, an excellent substrate, turns to a harmful one, able to worsen brain outcome, likely due to its needing phosphorylation prior to be utilized. Un-phosphorylated galactose can be utilized by Hexose phosphate dehydrogenase.
Awareness that conditions of extreme cellular ATP deficit may lead to a vicious cycle in which glucose would not be freely available as a substrate may rise studies for applying new strategies in clinical practice in the future. The need to balance among the opportunity to avoid both hypo- and hyper-glycaemia tells us that we may have missed the opportunity to learn from Nature how to care for both resuscitated newborns and critically-ill adults. A far-fetched hypothesis arises that to ameliorate long-term brain outcomes, we may imitate Nature which, to start up glucose catabolism, offers a solution composed of 50% glucose and 50% galactose.