Wysokodawkowa terapia insuliną lispro, chlorkiem potasu i glukozą u pacjentów z ostrym kardiogennym wstrząsem nie toksycznym

Baseline Assessment

After enrollment, you will undergo baseline measurements that include insertion of a pulmonary artery catheter for continuous monitoring of heart function, blood sampling for laboratory tests, and an echocardiographic Examination of the heart.

Baseline data will also include kidney function tests, blood pressure, heart rate, and a calculation of the SOFA score, which reflects the severity of organ failure.

Start of high-dose insulin euglycemic therapy

The study medication insulin lispro will be administered by continuous infusion at a total dose of 24000 iu, delivered through an intravenous line.

To prevent low blood sugar, a 50% glucose solution will be infused simultaneously; the prescribed volume is 2000 ml.

To maintain normal potassium levels, a potassium chloride concentrate will be added to the infusion at a total dose of 750 (units as specified by the study protocol).

The combined infusion is intended to continue for up to 48 hours while you are closely monitored.

Continuous monitoring during infusion

Throughout the 48‑hour infusion period, you will be monitored continuously for heart rate, mean arterial blood pressure, oxygen saturation, and electrocardiographic activity.

The pulmonary artery catheter will provide real‑time data on cardiac output, pulmonary vascular resistance, mixed venous oxygen saturation (svO2), and carbon dioxide levels.

Blood glucose and electrolyte levels, including potassium, will be checked regularly, and the infusion rates of insulin, glucose, and potassium may be adjusted according to the results.

48‑hour evaluation

After 48 hours, the study team will repeat the hemodynamic measurements, blood sampling, and echocardiography performed at baseline.

The comparisons will focus on changes in cardiac output, pulmonary vascular resistance, svO2, lactate, NT‑probnpp, left ventricular ejection fraction, kidney function, heart rate, blood pressure, and the SOFA score.

Termination of infusion and post‑infusion care

Once the 48‑hour Assessment is completed, the infusion of insulin lispro, glucose, and potassium chloride will be stopped.

You will continue to receive standard treatment for non‑toxic acute cardiogenic shock, and the medical team will monitor you for any delayed adverse effects.

6‑week follow‑up

Approximately six weeks after the start of the study, you will be asked to attend a follow‑up visit.

The follow‑up will assess survival without the need for mechanical circulatory support, repeat echocardiography to measure left ventricular ejection fraction, and repeat kidney function tests (eGFR and plasma urea).