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Kapadohos T, Angelopoulos E, Vasileiadis I, Nanas S, Kotanidou A, Karabinis A, Marathias K, Routsi C. Determinants of prolonged intensive care unit stay in patients after cardiac surgery: a prospective observational study. J Thorac Dis 2017; 9:70-79. [PMID: 28203408 DOI: 10.21037/jtd.2017.01.18] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Prolonged intensive care unit (ICU) stay of patients after cardiac surgery has a major impact on overall cost and resource utilization. The aim of this study was to identify perioperative factors which prolong stay in ICU. METHODS All adult patients from a single, specialized cardiac center who were admitted to the ICU after cardiac surgery during a 2-month period were included. Demographic and clinical characteristics, comorbidities, preoperative use of drugs, intraoperative variables, and postoperative course were recorded. Hemodynamic and blood gas measurements were recorded at four time intervals during the first 24 postoperative hours. Routine hematologic and biochemical laboratory results were recorded preoperatively and in the first postoperative hours. RESULTS During the study period 145 adult patients underwent cardiac surgery: 65 (45%) underwent coronary artery bypass graft surgery, 38 (26%) valve surgery, 26 (18%) combined surgery and 16 (11%) other types of cardiac operation. Seventy nine (54%) patients had an ICU stay of less than 24 hours. Random forests analysis identified four variables that had a major impact on the length of stay (LOS) in ICU; these variables were subsequently entered in a logistic regression model: preoperative hemoglobin [odds ratio (OR) =0.68], duration of aortic clamping (OR =1.01) and ratio of arterial oxygen partial pressure to inspired oxygen fraction (PaO2/FiO2) (OR =0.99) and blood glucose during the first four postoperative hours (OR =1.02). ROC curve analysis showed an AUC =0.79, P<0.001, 95% CI: 0.71-0.86. CONCLUSIONS Low preoperative hemoglobin, prolonged aortic clamping time and low PaO2/FiO2 ratio and blood glucose measured within the first postoperative hours, were strongly related with prolonged LOS in ICU.
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Affiliation(s)
- Theodore Kapadohos
- Department of Nursing, Faculty of Health and Caring Professions, Technological Educational Institute of Athens, Athens, Greece
| | - Epameinondas Angelopoulos
- First Department of Intensive Care, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - Ioannis Vasileiadis
- Intensive Care Unit, First Department of Respiratory Medicine, School of Medicine, National and Kapodistrian University of Athens, Sotiria Hospital, Athens, Greece
| | - Serafeim Nanas
- First Department of Intensive Care, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - Anastasia Kotanidou
- First Department of Intensive Care, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - Andreas Karabinis
- Surgical Intensive Care Unit, Onassis Cardiac Surgery Center, Athens, Greece
| | - Katerina Marathias
- Surgical Intensive Care Unit, Onassis Cardiac Surgery Center, Athens, Greece
| | - Christina Routsi
- First Department of Intensive Care, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
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Ng RRG, Myat Oo A, Liu W, Tan TE, Ti LK, Chew STH. Changing glucose control target and risk of surgical site infection in a Southeast Asian population. J Thorac Cardiovasc Surg 2015; 149:323-8. [DOI: 10.1016/j.jtcvs.2014.08.076] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 08/02/2014] [Accepted: 08/20/2014] [Indexed: 12/18/2022]
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Kohl BA, Hammond MS, Ochroch EA. Implementation of an intraoperative glycemic control protocol for cardiac surgery in a high-acuity academic medical center: an observational study. J Clin Anesth 2013; 25:121-8. [PMID: 23333786 DOI: 10.1016/j.jclinane.2012.06.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Revised: 06/22/2012] [Accepted: 06/25/2012] [Indexed: 01/01/2023]
Abstract
STUDY OBJECTIVE To examine the effect on morbidity and mortality of an established intraoperative insulin protocol in cardiac surgical patients. DESIGN Retrospective observational study. SETTING Single-center, 782 bed, metropolitan academic hospital. PATIENTS 1,616 adult patients undergoing cardiac surgical procedures with cardiopulmonary bypass (CPB). INTERVENTIONS An intraoperative, intravenous (IV) insulin protocol designed to maintain blood glucose values less than 150 mg/dL was implemented. MEASUREMENTS Blood glucose was evaluated on entry to the operating room, every 30 minutes during CPB, and at least once after discontinuation of CPB. Blood glucose values were followed postoperatively, as dictated by institutional policy. MAIN RESULTS Intraoperative predictors of 30-day mortality using multivariate logistic regression included hyperglycemia on initiation of CPB (OR 1.0, P = 0.05). The strongest predictor of 30-day mortality was the development of postoperative renal failure requiring hemodialysis (OR 3.26, P = 0.001). CONCLUSIONS Implementation of an intraoperative IV insulin protocol, while associated with improved glycemic control, was not associated with improved outcomes. While improved glycemic control on initiating CPB was associated with decreased 30-day mortality, the effect was small. Implementation of our insulin protocol was highly associated with decreased renal failure postoperatively. Further prospective studies are warranted to better establish causality.
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Affiliation(s)
- Benjamin A Kohl
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
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de Betue CTI, Verbruggen SCAT, Schierbeek H, Chacko SK, Bogers AJJC, van Goudoever JB, Joosten KFM. Does a reduced glucose intake prevent hyperglycemia in children early after cardiac surgery? a randomized controlled crossover study. Crit Care 2012; 16:R176. [PMID: 23031354 PMCID: PMC3682276 DOI: 10.1186/cc11658] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2012] [Revised: 08/14/2012] [Accepted: 10/02/2012] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Hyperglycemia in children after cardiac surgery can be treated with intensive insulin therapy, but hypoglycemia is a potential serious side effect. The aim of this study was to investigate the effects of reducing glucose intake below standard intakes to prevent hyperglycemia, on blood glucose concentrations, glucose kinetics and protein catabolism in children after cardiac surgery with cardiopulmonary bypass (CPB). METHODS Subjects received a 4-hour low glucose (LG; 2.5 mg/kg per minute) and a 4-hour standard glucose (SG; 5.0 mg/kg per minute) infusion in a randomized blinded crossover setting. Simultaneously, an 8-hour stable isotope tracer protocol was conducted to determine glucose and leucine kinetics. Data are presented as mean ± SD or median (IQR); comparison was made by paired samples t test. RESULTS Eleven subjects (age 5.1 (20.2) months) were studied 9.5 ± 1.9 hours post-cardiac surgery. Blood glucose concentrations were lower during LG than SG (LG 7.3 ± 0.7 vs. SG 9.3 ± 1.8 mmol/L; P < 0.01), although the glycemic target (4.0-6.0 mmol/L) was not achieved. No hypoglycemic events occurred. Endogenous glucose production was higher during LG than SG (LG 2.9 ± 0.8 vs. SG 1.5 ± 1.1 mg/kg per minute; P = 0.02), due to increased glycogenolysis (LG 1.0 ± 0.6 vs. SG 0.0 ± 1.0 mg/kg per minute; P < 0.05). Leucine balance, indicating protein balance, was negative but not affected by glucose intake (LG -54.8 ± 14.6 vs. SG -58.8 ± 16.7 μmol/kg per hour; P = 0.57). CONCLUSIONS Currently recommended glucose intakes aggravated hyperglycemia in children early after cardiac surgery with CPB. Reduced glucose intake decreased blood glucose concentrations without causing hypoglycemia or affecting protein catabolism, but increased glycogenolysis. TRIAL REGISTRATION Dutch trial register NTR2079.
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Affiliation(s)
- Carlijn TI de Betue
- Intensive Care and Department of Pediatric Surgery, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Dr. Molewaterplein 60, 3015 GJ, Rotterdam, The Netherlands
| | - Sascha CAT Verbruggen
- Department of Pediatrics, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Dr. Molewaterplein 60, 3015 GJ, Rotterdam, The Netherlands
| | - Henk Schierbeek
- Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Meibergdreef 9. 1105 AZ, Amsterdam, The Netherlands
| | - Shaji K Chacko
- Department of Pediatrics, Baylor College of Medicine, USDA-ARS Children's Nutrition Research Center, 1100 Bates Street, Houston, TX 77030, USA
| | - Ad JJC Bogers
- Department of Cardiothoracic Surgery, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands
| | - Johannes B van Goudoever
- Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Meibergdreef 9. 1105 AZ, Amsterdam, The Netherlands
- Department of Pediatrics, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Koen FM Joosten
- Department of Pediatrics, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Dr. Molewaterplein 60, 3015 GJ, Rotterdam, The Netherlands
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Abstract
Glycemic control in postoperative cardiac patients is necessary to improve outcomes in wound infection and overall mortality. In recent years, clinical trials evaluating blood glucose control in critically ill patients advocated for intense blood glucose management and found a significant reduction in morbidity and mortality. Some organizations published recommendations regarding blood glucose management in critically ill patients reflecting this information. However, recent clinical trials evaluating blood glucose target ranges in critically ill patients have found conflicting results, which has prompted reevaluation of current goals and guidelines, allowing for less stringent blood glucose target ranges. With the inconsistency of clinical trials evaluating a target blood glucose range for critically ill patients, specifically postoperative cardiac surgery patients, the target blood glucose range is still not clearly defined. Additional comparisons of specific glucose ranges would allow for a clearer definition of recommended blood glucose goals to target in postoperative cardiac patients.
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Affiliation(s)
- Theresa Breithaupt
- Department of Pharmacy Services, Baylor University Medical Center, Dallas, Texas
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Ascione R, Rogers CA, Rajakaruna C, Angelini GD. Inadequate blood glucose control is associated with in-hospital mortality and morbidity in diabetic and nondiabetic patients undergoing cardiac surgery. Circulation 2008; 118:113-23. [PMID: 18591441 DOI: 10.1161/circulationaha.107.706416] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Derangement of glucose metabolism after surgery is not specific to patients with diabetes mellitus. We investigated the effect of different degrees of blood glucose control (BGC) on clinical outcomes after cardiac surgery. METHODS AND RESULTS We analyzed 8727 adults operated on between April 1996 and March 2004. The highest blood glucose level recorded over the first 60 hours postoperatively was used to classify patients as having good (<200 mg/dL), moderate (200 to 250 mg/dL), or poor (>250 mg/dL) BGC; 7547 patients (85%) had good, 905 (10%) had moderate, and 365 (4%) had poor BGC. Patients with inadequate BGC were more likely to present with advanced New York Heart Association class, congestive heart failure, hypertension, renal dysfunction, and ejection fraction <50% (P0<or=.001). We found that 52% of patients with poor, 31% with moderate, and 8% with good BGC had diabetes mellitus. Inadequate BGC, but not diabetes mellitus (P=0.79), was associated with in-hospital mortality (good, 1.8%; moderate, 4.2%; poor, 9.6%; adjusted odds ratio: poor versus good BGC, 3.90 [95% confidence interval, 2.47 to 6.15]; moderate versus good BGC, 1.68 [95% confidence interval, 1.25 to 2.25]). Inadequate BGC also was associated with postoperative myocardial infarction (eg, odds ratio, poor versus good BGC: 2.73 [95% confidence interval, 1.74 to 4.26]) and with pulmonary and renal complications in patients without known diabetes mellitus (eg, odds ratio, poor versus good BGC: 2.27 [95% confidence interval, 1.65 to 3.12] and 2.82 [95% confidence interval, 1.54 to 5.14] respectively). CONCLUSIONS More than 50% of patients with moderate to poor BGC after cardiac surgery were not previously identified as diabetic. Inadequate postoperative BGC is a predictor of in-hospital mortality and morbidity.
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Affiliation(s)
- R Ascione
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
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Lorenz RA, Lorenz RM, Codd JE. Perioperative blood glucose control during adult coronary artery bypass surgery. AORN J 2005; 81:126-44, 147-50; quiz 151-4. [PMID: 15693687 DOI: 10.1016/s0001-2092(06)60066-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Coronary artery bypass graft (CABG) procedures are among the most frequently performed surgical procedures in the United States. People with cardiovascular disease who also have diabetes have a greater risk of poor outcomes after CABG procedures than patients who do not have diabetes. This literature review examines current information regarding perioperative blood glucose (BG) control. It emphasizes BG control in adults during the hypothermic period of cardiopulmonary bypass. Hyperglycemia, not the diagnosis of diabetes, significantly increases the risk of adverse clinical outcomes, longer hospitalizations, and increased health care costs.
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Gustafson PA, Zarro DL, Palanzo DA, Manley NJ, Montesano RM, Quinn M, Elmore BA, Castagna JM. Conventional approach to glucose management for diabetic patients undergoing coronary artery bypass surgery. Perfusion 2002; 17:141-4. [PMID: 11958305 DOI: 10.1191/0267659102pf539oa] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Continuous insulin infusion was not an effective mode of treatment in maintaining safe blood glucose levels (<200 mg/dl) during the intraoperative period of diabetic patients requiring open-heart surgery. The two modifications investigated to gain better control of the blood glucose were a change in the base solution of the cardioplegia and the use of a sliding insulin scale. Fifty patients including Type I and Type II diabetics were selected for the purpose of this study. The patients were then randomly divided into two groups categorized by the type of cardioplegic solution administered and the mode of insulin treatment. Group I patients received a dextrose 5%-based cardioplegic solution and blood glucose was treated via continuous intravenous insulin infusion. Group II patients received normal saline 0.9%-based cardioplegic solution and blood glucose was treated via sliding scale. Blood glucose levels were monitored pre- and postcardiopulmonary bypass (CPB) and every 30 min while on CPB. Glucose values were analyzed by group t test. A p value of <0.05 was considered statistically significant. When comparing Group I (mean=258 mg/dl) with Group II (mean=158 mg/dl), there was a statistically significant difference between the glucose values at each of the time intervals when the glucose values were recorded. In conclusion, Group II maintained an acceptable blood glucose level (<200 mg/dl) throughout the entire intraoperative period, which suggests that the combination of the sliding insulin scale and modification of the base cardioplegic solution was an effective mode of treatment.
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Anderson RV, Siegman MG, Balaban RS, Ceckler TL, Swain JA. Hyperglycemia increases cerebral intracellular acidosis during circulatory arrest. Ann Thorac Surg 1992; 54:1126-30. [PMID: 1449297 DOI: 10.1016/0003-4975(92)90080-n] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Phosphorus 31 nuclear magnetic resonance spectroscopy was used to assess cerebral high-energy phosphate metabolism and intracellular pH in normoglycemic and hyperglycemic sheep during hypothermic circulatory arrest. Two groups of sheep (n = 8 per group) were placed in a 4.7-T magnet and cooled to 15 degrees C using cardiopulmonary bypass. Spectra were acquired before and during circulatory arrest and during reperfusion and rewarming. Intracellular pH and adenosine triphosphate levels decreased during circulatory arrest. Compared with the normoglycemic animals, the hyperglycemic group was significantly more acidotic with the greatest difference observed during the first 20 minutes of reperfusion (6.40 +/- 0.08 versus 6.08 +/- 0.06; p < 0.001). Intracellular pH returned to baseline after 30 minutes of reperfusion in the normoglycemic group but did not reach baseline until 1 hour of reperfusion in the hyperglycemic animals. Adenosine triphosphate levels were significantly higher in the hyperglycemic group during circulatory arrest. Repletion of adenosine triphosphate during reperfusion was similar for both groups. These results support the hypothesis that hyperglycemia during cerebral ischemia drives anaerobic glycolysis and thus leads to increased lactate production and an increase [corrected] in the intracellular acidosis normally associated with ischemia.
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Affiliation(s)
- R V Anderson
- Surgery Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
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Schmeling DJ, Coran AG. Hormonal and metabolic response to operative stress in the neonate. JPEN J Parenter Enteral Nutr 1991; 15:215-38. [PMID: 2051562 DOI: 10.1177/0148607191015002215] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
It is evident from this review that newborns, even those born prematurely, are capable of mounting an endocrine and metabolic response to operative stress. Unfortunately, many of the areas for which a relatively well-characterized response exists in adults are poorly documented in neonates. As is the case in adults, the response seems to be primarily catabolic in nature because the combined hormonal changes include an increased release of catabolic hormones such as catecholamines, glucagon, and corticosteroids coupled with a suppression of and peripheral resistance to the effects of the primary anabolic hormone, insulin.
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Affiliation(s)
- D J Schmeling
- Section of Pediatric Surgery, Mott Children's Hospital, Ann Arbor, Michigan 48109-0245
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Spetzler RF, Hadley MN, Rigamonti D, Carter LP, Raudzens PA, Shedd SA, Wilkinson E. Aneurysms of the basilar artery treated with circulatory arrest, hypothermia, and barbiturate cerebral protection. J Neurosurg 1988; 68:868-79. [PMID: 3373282 DOI: 10.3171/jns.1988.68.6.0868] [Citation(s) in RCA: 289] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Complete circulatory arrest, deep hypothermia, and barbiturate cerebral protection are efficacious adjuncts in the surgical treatment of selected giant intracranial aneurysms. These techniques were utilized in seven patients, one with a large and six with giant basilar artery aneurysms; four had excellent results, one had a good result, one had a fair outcome, and one died. The rationale for the use of complete cardiac arrest with extracorporeal circulation, hypothermia, and barbiturate cerebral protection is outlined. The surgical and anesthetic considerations are reviewed. The perioperative morbidity and long-term results support the use of these techniques in selected patients with complex intracranial vascular lesions.
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Affiliation(s)
- R F Spetzler
- Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona
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Thomas DJ, Hinds CJ, Rees GM. The management of insulin dependent diabetes during cardiopulmonary bypass and general surgery. Anaesthesia 1983; 38:1047-52. [PMID: 6356973 DOI: 10.1111/j.1365-2044.1983.tb12478.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Two groups of insulin dependent diabetic subjects have been studied: six undergoing general surgical procedures and six undergoing hypothermic cardiopulmonary bypass surgery for coronary artery vein grafting. Intravenous glucose insulin mixtures were infused from the onset of surgery in both groups of patients, supplying 0.4 units of insulin per gram of glucose per hour, and 0.6 units of insulin per gram of glucose per hour in general and cardiac surgical patients respectively. Postoperatively diabetes was controlled carefully with an insulin syringe pump regulated by venous blood glucose monitoring. In cardiac surgical patients far more insulin was required to control diabetes postoperatively than in the general surgery patients (at 1 hour 1.6 units, SEM 0.4 compared to 0.7 SEM 0.1, p less than 0.05; and at 4 hours 2.0 units SEM 0.3 compared to 0.8 units SEM 0.1, p less than 0.02). Five non-diabetic subjects who underwent surgery for coronary artery venous bypass grafting were also studied. They developed significant postoperative hyperglycaemia (5.0, SEM 0.2, mmol/litre pre-operatively, compared with 8.8, SEM 0.7, mmol/litre p less than 0.03 at 1 hour and 10.2, SEM 1.7, mmol/litre, p less than 0.02 at 4 hours after bypass terminated).
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Rochedreux A, Souron R, Bizais Y, Nicolas F. [Development of blood sugar and insulinemia in the first 12 postoperative hours. Effects of glucose and insulin intake]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 1982; 1:291-6. [PMID: 6762118 DOI: 10.1016/s0750-7658(82)80044-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Serum levels of glucose and insulin are studied during 12 hours in the early post-operative period after intra-abdominal surgery. Five groups of non diabetic patients are perfused with incremental doses of glucose, G. I: no glucose, G. II: 8,33 g . h-1 of glucose during 6 hours, G. III: 16,66 g . h-1 of glucose during 6 hours, G. IV: 16,66 g . h-1 of glucose with 20 mu insulin; G. V: 16,66 g . h-1 of glucose with 40 mu insulin. In all groups a significant rise in serum levels of glucose is observed (10,5-15,6 mmol . l-1). At the same time serum level of insulin remains unchanged except when insulin is infused. However exogenous insulin is unable to prevent the serum level of glucose to rise post-operatively.
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Kaminski MV. A review of hypersomolar hyperglycemic nonketotic dehydration (HHND): etiology, pathophysiology and prevention during intravenous hyperalimentation. JPEN J Parenter Enteral Nutr 1978; 2:690-8. [PMID: 109637 DOI: 10.1177/014860717800200513] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The records of 200 patients, nutritionally supported by synthetic means, were reviewed for evidence of clinical hyperosmolar hyperglycemic nonketotic dehydration (HHND). There was a 3% incidence of morbidity, with a single mortality. Laboratory values demonstrated a positive correlation between persistent glucosuria and HHND. The pathophysiology of HHND demonstrated a relative insulin lack with sufficient insulin to prevent lipolysis, but insufficient to prevent hyperglycemia, glucosuria and osmotic diuresis. The mechanism and management of the pseudodiabetes of stress is reviewed. It is concluded that HHND is an avoidable iatrogenic morbidity. Prevention of osmotic diuresis secondary to glucosuria and, therefore, prevention of HHND is achieved by providing exogenous insulin sufficient to prevent glucosuria.
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Yokota H, Kawashima Y, Takao T, Hashimoto S, Manabe H. Carbohydrate and lipid metabolism in open-heart surgery. J Thorac Cardiovasc Surg 1977. [DOI: 10.1016/s0022-5223(19)39891-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Rawlings C, Bisgard G, Dufek J, Buss D, Will J, Birnbaum M, Chopra P, Kahn D. Prolonged perfusion with a membrane oxygenator in awake ponies. J Thorac Cardiovasc Surg 1975. [DOI: 10.1016/s0022-5223(19)41533-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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