Perioperative control of blood glucose level in cardiac surgery
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It is well recognized that poor perioperative blood glucose (BG) control can increase the risk of infection, cardiovascular accidents, and even death in patients undergoing cardiac surgery. Since it has been reported that tight BG control (80–110 mg/dL) yields better outcomes in critically ill patients, it became a standard of care to control BG using intravenous insulin infusion in ICU. However, it has been debated in terms of the optimal target range whether a strict control with intensive insulin therapy is better than liberal control. Because strict BG control can often cause hypoglycemia, which in turn increases the hospital mortality. In fact, a meta-analysis of randomized clinical trials concluded that tight BG control was not associated with significantly reduced hospital mortality but was associated with an increased risk of hypoglycemia. According to the current published guidelines, it seems to be optimal to control BG level of 140–180 mg/dL in ICU. In terms of more strict BG control (110–140 mg/dL), it may be appropriate in selected patients as long as this can be achieved without significant hypoglycemia.
- Bonow RO, Gheorghiade M. The diabetes epidemic: a national and global crisis. Am J Med. 2004;116 Suppl 5A:2S–10S.
- Annual report from the national survey of life and nutrition 2007, the Ministry of Health, Labour and Welfare of Japan (Japanese). http://www.mhlw.go.jp/houdou/2008/12/h1225-5.html.
- Flaherty JD, Davidson CJ. Diabetes and coronary revascularization. JAMA. 2005;293:1501–8. CrossRef
- Brener SJ, Lytle BW, Casserly IP, Schneider JP, Topol EJ, Lauer MS. Propensity analysis of long-term survival after surgical or percutaneous revascularization in patients with multivessel coronary artery disease and high-risk features. Circulation. 2004;109:2290–5. CrossRef
- Hlatky MA, Boothroyd DB, Bravata DM, Boersma E, Booth J, Brooks MM, et al. Coronary artery bypass surgery compared with percutaneous coronary interventions for multivessel disease: a collaborative analysis of individual patient data from ten randomised trials. Lancet. 2009;373:1190–7. CrossRef
- Minakata K, Bando K, Takanashi S, Konishi H, Miyamoto Y, Ueshima K, et al. Impact of diabetes mellitus on outcomes in Japanese patients undergoing coronary artery bypass grafting. J Cardiol. 2012;59:275–84. CrossRef
- Brown JR, Edwards FH, O’Connor GT, Ross CS, Furnary AP. The diabetic disadvantage: historical outcomes measures in diabetic patients undergoing cardiac surgery—the pre-intravenous insulin era. Smin Thorac Cardiovasc Surg. 2006;18:281–8. CrossRef
- Szabó Z, Håkanson E, Svedjeholm R. Early postoperative outcome and medium-term survival in 540 diabetic and 2239 nondiabetic patients undergoing coronary artery bypass grafting. Ann Thorac Surg. 2002;74:712–9. CrossRef
- Zerr KJ, Furnary AP, Grunkemeier GL, Bookin S, Kanhere V, Starr A. Glucose control lowers the risk of wound infection in diabetics after open heart operations. Ann Thorac Surg. 1997;63:356–61. CrossRef
- Lazar HL. Alterations in myocardial metabolism in the diabetic myocardium. Sem Thorac Cardiovasc Surg. 2006;18:289–92. CrossRef
- Lazar HL, Chipkin SR, Fitzgerald CA, Bao Y, Cabral H, Apstein CS. Tight glycemic control in diabetic coronary artery bypass graft patients improves perioperative outcomes and decreases recurrent ischemic events. Circulation. 2004;109:1497–502. CrossRef
- Furnary AP, Gao G, Grunkemeier GL, Wu Y, Zerr KJ, Bookin SO, et al. Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2003;125:1007–21. CrossRef
- Furnary AP, Wu Y. Eliminating the diabetic disadvantage: the Portland Diabetic Project. Semin Thorac Cardiovasc Surg. 2006;18:302–8. CrossRef
- Fujii T, Watanabe Y, Shiono N, Kawasaki M, Yokomuro H, Ozawa T, et al. Usefulness of perioperative blood glucose control in patients undergoing off-pump coronary artery bypass grafting. Gen Thorac Cardiovasc Surg. 2007;55:409–15. CrossRef
- Furnary AP, Zerr KJ, Grunkemeier GL, Starr A. Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures. Ann Thorac Surg. 1999;67:352–60. CrossRef
- Kelly JL, Hirsch IB, Furnary AP. Implementing an intravenous insulin protocol in your practice: practical advice to overcome clinical, administrative, and financial barriers. Semin Thorac Cardiovasc Surg. 2006;18:346–58. CrossRef
- Halkos ME, Puskas JD, Lattouf OM, Kilgo P, Kerendi F, Song HK, et al. Elevated preoperative hemoglobin A1c level is predictive of adverse events after coronary artery bypass surgery. J Thorac Cardiovasc Surg. 2008;136:631–40. CrossRef
- Doenst T, Wijeysundera D, Karkouti K, Zechner C, Maganti M, Rao V, et al. Hyperglycemia during cardiopulmonary bypass is an independent risk factor for mortality in patients undergoing cardiac surgery. J Thorac Cardiovasc Surg. 2005;130:1144. CrossRef
- Gandhi GY, Nuttall GA, Abel MD, Mullany CJ, Schaff HV, Williams BA, et al. Intraoperative hyperglycemia and perioperative outcomes in cardiac surgery patients. Mayo Clin Proc. 2005;80:862–6. CrossRef
- Gandhi GY, Nuttall GA, Abel MD, Mullany CJ, Schaff HV, O’Brien PC, et al. Intensive intraoperative insulin therapy versus conventional glucose management during cardiac surgery: a randomized trial. Ann Intern Med. 2007;146:233–43.
- Chaney MA, Nikolov MP, Blakeman BP, Bakhos M. Attempting to maintain normoglycemia during cardiopulmonary bypass with insulin may initiate postoperative hypoglycemia. Anesth Analg. 1999;89:1091–5. CrossRef
- Van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, et al. Intensive insulin therapy in the critically ill patients. N Engl J Med. 2001;345:1359–67. CrossRef
- D’Alessandro C, Leprince P, Golmard JL, Ouattara A, Aubert S, Pavie A, et al. Strict glycemic control reduces EuroSCORE expected mortality in diabetic patients undergoing myocardial revascularization. J Thorac Cardiovasc Surg. 2007;134:29–37. CrossRef
- Wiener RS, Wiener DC, Larson RJ. Benefits and risks of tight glucose control in critically ill adults: a meta-analysis. JAMA. 2008;300:933–44. CrossRef
- NICE-SUGAR Study Investigators, Finfer S, Chittock DR, Su SY, Blair D, Foster D, Dhingra V, et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360:1283–97. CrossRef
- Hermanides J, Bosman RJ, Vriesendorp TM, Dotsch R, Rosendaal FR, Zandstra DF, et al. Hypoglycemia is associated with intensive care unit mortality. Crit Care Med. 2010;38:1430–4. CrossRef
- Bhamidipati CM, LaPar DJ, Stukenborg GJ, Morrison CC, Kern JA, Kron IL, et al. Superiority of moderate control of hyperglycemia to tight control in patients undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2011;141:543–51. CrossRef
- Egi M, Bellomo R, Stachowski E, French CJ, Hart G. Variability of blood glucose concentration and short-term mortality in critically ill patients. Anesthesiology. 2006;105:244–52. CrossRef
- Hermanides J, Vriesendorp TM, Bosman RJ, Zandstra DF, Hoekstra JB, Devries JH. Glucose variability is associated with intensive care unit mortality. Crit Care Med. 2010;38:838–42. CrossRef
- American Diabetes Association. Executive summary: standards of medical care in diabetes—2012. Diabetes Care. 2012;35(Suppl 1):S4–10.
- Lazar HL, McDonnell M, Chipkin SR, Furnary AP, Engelman RM, Sadhu AR, et al. The Society of Thoracic Surgeons Practice Guideline Series: blood glucose management during adult cardiac surgery. Ann Thorac Surg. 2009;87:663–9. CrossRef
- Qaseem A, Humphrey LL, Chou R, Snow V, Shekelle P, The clinical Guidelines Committee of the American College of Physicians. Use of intensive insulin therapy for the management of glycemic control in hospitalized patients: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2011;154:260–7.
- Perioperative control of blood glucose level in cardiac surgery
General Thoracic and Cardiovascular Surgery
Volume 61, Issue 2 , pp 61-66
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