Association of time in blood glucose range with outcomes following cardiac surgery

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• 作者：Amr S Omar (8) (9)
  Ahmed Salama (10) (8)
  Mahmoud Allam (10) (8)
  Yasser Elgohary (8)
  Shaban Mohammed (11)
  Alejandro Kohn Tuli (8)
  Rajvir Singh (12)
  
  8. Department of Cardiothoracic Surgery/Cardiac Anaesthesia & ICU Section ; Heart Hospital ; Hamad Medical Corporation ; Doha ; PO ; 3050 ; Qatar
  9. Department of Critical Care Medicine ; Beni Suef University ; Beni Suef ; Egypt
  10. Department of Anesthesia ; Al-Azhar University ; Cairo ; Egypt
  11. Department of Clinical Pharmacy ; Hamad Medical Corporation ; Doha ; Qatar
  12. Department of Medial Research ; Hamad Medical Corporation ; Doha ; Qatar
  
• 关键词：Glucose control ; Outcome ; Wound infection
• 刊名：BMC Anesthesiology
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：15
• 期：1
• 参考文献：1. Carr JM, Sellke FW, Fey M, Doyle MJ, Krempin JA, de la Torre R, Liddicoat JR: Implementing tight glucose control after coronary artery bypass surgery. / Ann Thorac Surg 2005,80(3):902-. 10.1016/j.athoracsur.2005.03.105 CrossRef
  2. Ouattara A, Lecomte P, Le Manach Y, Landi M, Jacqueminet S, Platonov I, Bonnet N, Riou B, Coriat P: Poor intraoperative blood glucose control is associated with a worsened hospital outcome after cardiac surgery in diabetic patients. / Anesthesiology 2005,103(4):687-4. 10.1097/00000542-200510000-00006 CrossRef
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  4. 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, 109:1497-02. 10.1161/01.CIR.0000121747.71054.79 CrossRef
  5. Furnary AP, Gao G, Grunkemeier GL, Wu Y, Zerr KJ, Bookin SO, Starr A: Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting. / J Thorac Cardiovasc Surg 2003, 125:1007-1. 10.1067/mtc.2003.181 CrossRef
  6. van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Bouillon R: Intensive insulin therapy in the critically ill patients. / N Engl J Med 2001, 345:1359-7. 10.1056/NEJMoa011300 CrossRef
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  8. 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-. 10.1213/00000539-199911000-00004 CrossRef
  9. Lehot JJ, Piriz H, Villard J, Cohen R, Guidollet J: Glucose homeostasis. Comparison between hypothermic and normothermic cardiopulmonary bypass. / Chest 1992, 102:106-1. 10.1378/chest.102.1.106 CrossRef
  10. Wasmuth HE, Kunz D, Graf J, Stanzel S, Purucker EA, Koch A, Lammert F: Hyperglycemia at admission to the intensive care unit is associated with elevated serum concentrations of interleukin-6 and reduced ex vivo secretion of tumor necrosis factor-alpha. / Crit Care Med 2004, 32:1109-4. 10.1097/01.CCM.0000124873.05080.78 CrossRef
  11. Macheda M, Rogers S, Best JD: Molecular and cellular regulation of glucose transporter (GLUT) proteins in cancer [Review]. / J Cell Physiol 2005, 202:654-2. 10.1002/jcp.20166
• 刊物主题：Anesthesiology; Internal Medicine; Emergency Medicine; Intensive / Critical Care Medicine;
• 出版者：BioMed Central
• ISSN：1471-2253

文摘

Background The importance of optimal postoperative glycemic control in cardiac patients remains unclear. Various glycemic targets have been prescribed to reduce wound infection and overall mortality rates. Aim of the work: To assess glucose control, as determined by time in range (TIR), in patients with glycemic targets of 6.0 to 8.1?mmol/L, and to determine factors related to poor control. Methods This prospective descriptive study evaluated 227 consecutive patients, 100 with and 127 without diabetes, after cardiac surgery. Patients received insulin to target glucose concentrations of 6.0 to 8.1?mmol/L. Data analyzed included patient age, gender, race, Euro score, cardiopulmonary bypass time (CPB), aortic cross clamp time (ACC), length of ventilation, stay in the intensive care unit (ICU) and stay in the hospital. Patients were divided into two groups, those who maintained--0% and--0% TIR. Outcome variables were compared in diabetics and non-diabetics. Results Patients with >80% and HbA1c)--% (p--.0001), and in patients taking dopamine (p--.04) and adrenaline (p--.05). Times of CPB and ACC, length of stay in the ICU and ventilation were significantly higher in patients with TIR 80%. Rates of hypoglycemia, acute kidney injury, and in-hospital mortality were similar in the two groups, although the incidence of wound infection was higher in patients with TIR Conclusion Patients with >80% TIR, whether or not diabetics, had better outcomes than those with