Réanimation métabolique du myocarde : à la redécouverte de l'insuline

Metabolic resuscitation of acute cardiac failure by insulin in intensive care patients includes three different therapeutic strategies, using different doses of insulin. The mechanisms of action, the potential indications and the specific limitations differ: (1) glucose-insulin-potassium (GIK) solutions are designed to switch the use of energy substrates from free fatty acids toward glucose; (2) intensive insulin therapy (IIT), focusing on strict blood glucose control, to avoid hyperglycaemia-induced toxicity; (3) high dose insulin (in the range of 1 IU/kg per hour) with or without glucose control able moreover to provide positive inotropism, cytoprotection and anti-apoptotic effects to cardiomyocytes. Cellular mecanisms of cardioprotection and the results of clinical trials are discussed.