Advertisement

Pediatric Cardiology

, Volume 33, Issue 1, pp 21–26 | Cite as

Postoperative Outcome for Hyperglycemic Pediatric Cardiac Surgery Patients

  • Fariba AlaeiEmail author
  • Paridokht Nakhostin Davari
  • Mastaneh Alaei
  • Rasoul Azarfarin
  • Ebrahim Soleymani
Original Article

Abstract

This prospective cohort study aimed to determine the morbidity and mortality among hyperglycemic pediatric patients after cardiac surgery. The study was conducted in a pediatric intensive care unit (PICU) for cardiac surgery patients at a university-affiliated, referral, heart hospital. A total of 379 postcardiac surgery pediatric patients participated in the study. No interventions were performed. Measurements of blood glucose level together with other clinical and laboratory data were collected on postoperative days 1, 2, 3, and 7. Mean blood glucose level exceeding 126 mg/dl was considered hyperglycemia, and a level exceeding 200 mg/dl determined severe hyperglycemia. These measurements were analyzed for association with major complications and death. Hyperglycemia was common (86%) in this cohort study. There was no statistical correlation between hyperglycemia and death or major complications, but patients with severe hyperglycemia showed a significantly higher mortality rate (16/64 deaths [25%] vs. 13/315 deaths [4.12%]; P < 0.001]) and more morbidities (16/64 [25%] vs. 43/315 [13.65%]; P = 0.022). Severe hyperglycemia was independently associated with mortality according to multivariate logistic regression. Hyperglycemia is quite prevalent among pediatric patients after cardiac surgeries. Severe hyperglycemia is associated with higher morbidity and mortality rates in this patient population.

Keywords

Cardiac surgery Children Hyperglycemia Intensive care Morbidity Mortality 

References

  1. 1.
    Anderson RE, Tan WK, Martin HS, Meyer FB (1999) Effects of glucose and PaO2 modulation on cortical intracellular acidosis, NADH redox state, and infarction in the ischemic penumbra. Stroke 30:160–170PubMedCrossRefGoogle Scholar
  2. 2.
    Azarfarin R, Alizadeh Asl A (2008) Prevalence and intensity of hyperglycemia in nondiabetic patients undergoing coronary artery bypass graft surgery with and without cardiopulmonary bypass. Saudi Med J 29:1294–1298PubMedGoogle Scholar
  3. 3.
    Bell C, Hughes CW, Oh TH, Donielson DW, O’Connor T (1993) The effect of intravenous dextrose infusion on post bypass hyperglycemia in pediatric populations undergoing cardiac operations. J Clin Anesth 5:381–385PubMedCrossRefGoogle Scholar
  4. 4.
    Bochicchio GV, Sung J, Joshi M, Bochicchio K, Johnson SB, Meyer W, Scalea TM (2005) Persistent hyperglycemia is predictive of outcome in critically ill trauma patients. J Trauma 59:1277–1278CrossRefGoogle Scholar
  5. 5.
    Branco RG, Tasker RC (2007) Glycemic level in mechanically ventilated children with bronchiolitis. Pediatr Crit Care Med 8:546–550PubMedCrossRefGoogle Scholar
  6. 6.
    Fahy BG, Sheehy AM, Coursin DB (2009) Glucose control in the intensive care unit. Crit Care Med 37:1769–1776PubMedCrossRefGoogle Scholar
  7. 7.
    Falco G, Ulate K, Kouzekanani K, Bielefeld MR, Morales JM, Rotta AT (2008) Impact of postoperative hyperglycemia following surgical repair of congenital cardiac defects. Pediatr Cardiol 29:628–636CrossRefGoogle Scholar
  8. 8.
    Foia L, Costuleanu N, Trandafirescu M, Saila V, Pavel M (1999) Glucose metabolic change in stress (abstract). Rev Med Chir Sog Nat Lasi 103:69–73Google Scholar
  9. 9.
    Gearhart MM, Parbhoo SK (2006) Hyperglycemia in the critically ill patient. AACN Clin Issues 17:50–55PubMedCrossRefGoogle Scholar
  10. 10.
    Gor DC, Chinkes D, Heggers J, Herndon DN, Wolf SE, Desai M (2001) Association of hyperglycemia with increased mortality after severe burn injury. J Trauma 51:540–544CrossRefGoogle Scholar
  11. 11.
    Griesdale DL, De Souza RJ, Van Dam RM, Heyland DK, Cook DJ, Malhotra A, Dhaliwal R, Henderson WR, Chittock DR, Finfer S, Talmor D (2009) Intensive insulin therapy and mortality among critically ill patients: a meta-analysis including NICE-SUGAR study data. CMAJ 180:821–827PubMedCrossRefGoogle Scholar
  12. 12.
    Hirshberg E, Larsen G, Van Duker H (2008) Alteration in glucose homeostasis in the pediatric intensive care unit: hyperglycemia and glucose variability are associated with increased mortality and morbidity. Pediatr Crit Care Med 9:361–366PubMedCrossRefGoogle Scholar
  13. 13.
    Kong MY, Alten J, Tofil N (2007) Is hyperglycemia really harmful? A critical appraisal of “persistent hyperglycemia in critically ill children” by Faustino and Apkon. Pediatr Crit Care Med 8:482–485PubMedCrossRefGoogle Scholar
  14. 14.
    Lou S, Ding F, Long C, Liu J, Zhao J, Feng Z (2011) Effects of perioperative glucose levels on adverse outcomes in infants receiving open heart surgery for congenital heart disease with cardiopulmonary bypass. Perfusion 26:133–139CrossRefGoogle Scholar
  15. 15.
    Maltinsky J, Vigas M, Jezova J, Samel M, Vrsansky D (1984) The effect of open heart surgery on growth hormone, cortisol, and insulin levels in man: hormone levels during open heart surgery. Resuscitation 11:57–68CrossRefGoogle Scholar
  16. 16.
    McCowen KC, Malhotra A, Bistrian BR (2001) Stress-induced hyperglycemia. Crit Care Clin 17:107–124PubMedCrossRefGoogle Scholar
  17. 17.
    Mekitarian Filho E, Carvalho WB, Troster EJ (2009) Hyperglycemia, morbidity, and mortality in critically ill children: critical analysis based on a systematic review (abstract). Rev Assoc Med Bras 55:475–483PubMedCrossRefGoogle Scholar
  18. 18.
    Moga MA, Manlhiot C, Marwali EM, McCrindle BW, Van Arsdell GS, Schwartz SM (2011) Hyperglycemia after pediatric cardiac surgery: impact of age and residual lesions. Crit Care Med 39:266–272PubMedCrossRefGoogle Scholar
  19. 19.
    Pressig CM, Hansen I, Roerig PL, Rigby MR (2008) A protocolized approach to identify and manage hyperglycemia in a pediatric critical care unit. Pediatr Crit Care Med 9:581–588CrossRefGoogle Scholar
  20. 20.
    Srinivasan V, Spinella PC, Drott HR, Roth CL, Helfaer MA, Nadkarni V (2005) Association of timing, duration, and intensity of hyperglycemia with intensive care unit mortality in critically ill children. Pediatr Crit Care Med 6:94–95CrossRefGoogle Scholar
  21. 21.
    Sung J, Bochicchio GV, Joshi M, Bochicchio K, Tracy K, Scalea TM (2005) Admission hyperglycemia is predictive of outcome in critically ill trauma patients. J Trauma 59:80–83PubMedCrossRefGoogle Scholar
  22. 22.
    Turina M, Fry DE, Polk HC Jr (2005) Acute hyperglycemia and the innate immune system: clinical, cellular, and molecular aspects. Crit Care Med 33:1624–1633PubMedCrossRefGoogle Scholar
  23. 23.
    Ulate KP, Lima Falco GC, Bielefeld MR, Morales JM, Rotta AT (2008) Strict glycemic targets need not be so strict: a more permissive glycemic range for critically ill children. Pediatrics 122:e898–e904PubMedCrossRefGoogle Scholar
  24. 24.
    Verhoeven JJ, Hokken-Koelega AC, Den Brinker M, Hop WC, Van Thiel RJ, Bogers AJ, Helbing WA, Joosten KF (2010) Disturbance of glucose homeostasis after pediatric cardiac surgery. Pediatr Cardiol 32:131–138PubMedCrossRefGoogle Scholar
  25. 25.
    Wernovsky G, Wypij D, Jonas RA, Mayer JE, Hanley FL, Hickey PR, Walsh AZ, Chang AC, Castaneda AR, Newburger JW, Wessel DL (1995) Postoperative course and hemodynamic profile after the arterial switch operation in neonates and infants: a comparison of low-flow cardiopulmonary bypass and circulatory arrest. Circulation 92:2226–2235PubMedGoogle Scholar
  26. 26.
    Yates AR, Dyke PC II, Taeed R, Hoffman TM, Hayes J, Feltes TF, Cua CL (2006) Hyperglycemia is a marker for poor outcome in the postoperative pediatric cardiac patient. Pediatr Crit Care Med 7:397–398CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Fariba Alaei
    • 1
    Email author
  • Paridokht Nakhostin Davari
    • 1
  • Mastaneh Alaei
    • 2
  • Rasoul Azarfarin
    • 3
  • Ebrahim Soleymani
    • 4
  1. 1.Department of Pediatric CardiologyRajaei Heart CenterTehranIran
  2. 2.Department of PathologyZanjan University of Medical ScienceZanjanIran
  3. 3.Department of AnesthesiologyTabriz University of Medical SciencesTabrizIran
  4. 4.Department of PathologyArtesh University of Medical SciencesTehranIran

Personalised recommendations