Perioperative blood glucose control during adult coronary artery bypass surgery (original) (raw)
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Prospective evaluation of glucose metabolism in patients undergoing coronary artery bypass grafting
2006
K Kr rz zy ys sz zt to of f G Gr re eb be er rs sk ki i 1 1 , , P Pr rz ze em my ys sł ła aw w G Gu uz zi ik k 2 2 , , H He en nr ry yk k W Wy ys so oc ck ki i 2 2 , , R Ry ys sz za ar rd d K Ka al la aw ws sk ki i 1 1 A b s t r a c t I In nt tr ro od du uc ct ti io on n: : Disturbances of glucose metabolism are associated with increased risk of ischaemic heart disease (IHD). It is not uncommon that IHD and its complications precede diagnosis of glucose metabolism disturbances. Since publication of the American Diabetes Association's 2004 Guidelines for the assessment of glucose metabolism, no prospective evaluation of prevalence of carbohydrate metabolism disorders in patients referred for coronary artery bypass grafting (CABG) has been performed.
Perioperative Blood Glucose Monitoring and Control in Major Vascular Surgery Patients
European Journal of Vascular and Endovascular Surgery, 2009
Diabetes mellitus (DM) is an independent predictor for morbidity and mortality in the general population, which is even more apparent in patients with concomitant cardiovascular risk factors. As the prevalence of DM is increasing, with an ageing general population, it is expected that the number of diabetic patients requiring surgical interventions will increase. Perioperative hyperglycaemia, without known DM, has been identified as a predictor for morbidity and mortality in patients undergoing surgery. Moreover, early studies showed that intensive blood-glucose-lowering therapy reduced both morbidity and mortality among patients admitted to the postoperative intensive care unit (ICU). However, later studies have doubted the benefit of intensive glucose control in medicalesurgical ICU patients. This article aims to comprehensively review the evidence on the use of perioperative intensive glucose control, and to provide recommendations for current clinical practice. A systematic review was performed of the literature on perioperative intensive glucose control. Based on this literature review, we observed that intensive glucose control in the perioperative period has no clear benefit on short-term mortality. Intensive glucose control may even have a net harmful effect in selected patients. In addition, concerns on the external validity of some studies are important barriers for widespread recommendation of intensive glucose control in the * Financial disclosure: J.P. van Kuijk and W.J.
The Annals of Thoracic Surgery, 2009
Background. Perioperative hyperglycemia should be avoided in patients undergoing coronary surgery. The aim of our study was to find out what the influence of cardiopulmonary bypass is on postoperative glycemia and insulin consumption in patients with and without diabetes mellitus undergoing coronary artery surgery and whether a marked hyperglycemia in the early postoperative period is among the factors associated with early mortality and morbidity.
Annals of Thoracic Surgery, 2003
The association between perioperative hyperglycemia and outcomes in patients with and without diabetes mellitus undergoing coronary artery bypass grafting is not well defined. We measured the association between perioperative hyperglycemia and outcomes among patients undergoing coronary artery bypass grafting.We report a historic cohort study of 1574 patients who had undergone coronary artery bypass grafting between 1998 and 1999, 545 (34.6%) with diabetes. Perioperative blood glucose level was defined as the average of all blood glucose tests obtained on the day of and the day after surgery. Outcomes were 30-day mortality, infection rates (sternum, harvest site, sepsis, pneumonia, urinary tract), and resource utilization.After adjusting for diabetes status and calculated preoperative mortality or mediastinitis risk scores, each 50 mg/dL (2.78 mmol/L) blood glucose increase was not statistically associated with higher mortality (odds ratio 1.37; 95% confidence interval, 0.98 to 1.92; p = 0.07), or higher infection rate (odds ratio 1.23, 95% confidence interval 0.94 to 1.60; p = 0.14). Each 50 mg/dL blood glucose increase was associated with longer postoperative days by 0.76 days (95% confidence interval 0.36 to 1.17 days; p < 0.001), increased hospitalization charges by 2824(952824 (95% confidence interval 2824(951599 to 4049;p<0.001),andincreasedhospitalizationcostby4049; p < 0.001), and increased hospitalization cost by 4049;p<0.001),andincreasedhospitalizationcostby1769 (95% confidence interval 928to928 to 928to2610; p < 0.001). In the unadjusted analysis, infections occurred more frequently in patients with diabetes (6.6% vs 4.1%, p = 0.03).Perioperative hyperglycemia is associated with increased resource utilization in patients undergoing coronary artery bypass grafting with and without diabetes.