Cardiopulmonary Bypass Increases Postoperative Glycemia and Insulin Consumption After Coronary Surgery

Knapik, Piotr; Nadziakiewicz, Paweł; Urbańska, Ewa; Saucha, Wojciech; Herdynska, Miroslawa; Zembala, Marian

doi:10.1016/j.athoracsur.2009.02.066

Cited by 52 publications

(50 citation statements)

References 29 publications

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“…These observations support the fact that diabetes per se, is a risk factor for coronary heart disease [1,18] and its more severe degree [19]. Furthermore, diabetes is associated with a greater number of surgical complications such as perioperative myocardial infarction [20], prolonged MV [20], infection [18] and cerebrovascular accidents [18], which prolongs the ICU. Also, the use of CPB worsens glycemic control, may increase the frequency of these complications [20].…”

Section: Bmi -Body Mass Index; Ef -Ejection Fraction; Oi-sc -Oxygenatsupporting

confidence: 58%

“…Furthermore, diabetes is associated with a greater number of surgical complications such as perioperative myocardial infarction [20], prolonged MV [20], infection [18] and cerebrovascular accidents [18], which prolongs the ICU. Also, the use of CPB worsens glycemic control, may increase the frequency of these complications [20]. Thus, the combination of diabetes with some of these variables can justify its expression as a risk factor.…”

Section: Bmi -Body Mass Index; Ef -Ejection Fraction; Oi-sc -Oxygenatmentioning

confidence: 99%

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Risk factors for prolonged hospital stay after isolated coronary artery bypass grafting

Oliveira¹,

Turquetto²,

Tauil³

et al. 2013

Revista Brasileira De Cirurgia Cardiovascular

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353Rev Bras Cir Cardiovasc | Braz J Cardiovasc SurgRev Bras Cir Cardiovasc 2013;28(3):353- ORIGINAL ARTICLE Abstract Introduction: Characteristics of the patient and the coronary artery bypass grafting may predispose individuals to prolonged hospitalization, increasing costs and morbidity and mortality.Objective: The objective of this study was to evaluate individual and perioperative risk factors of prolonged hospitalization in intensive care units and wards.Methods: We conducted a case-control study of 104 patients undergoing isolated coronary artery bypass grafting with cardiopulmonary bypass. Patients hospitalized >3 days in the intensive care unit or >7 days in the ward were considered for the study. The association between variables was estimated by the chi-square test, odds ratio and logistic regression; P ≤0.05 was considered statistically significant.Results: Hospital stay >3 days in the intensive care unit occurred for 22.1% of patients and >7 days in the ward for 27.9%. Among preoperative factors, diabetes (OR=3.17) and smoking (OR=4.07) were predictors of prolonged intensive care unit stay. Combining the pre-, intra-and postoperative variables, only mechanical ventilation for more than 24 hours (OR=6.10) was predictive of intensive care unit outcome. For the ward outcome, the preoperative predictor was left ventricular ejection fraction <50% (OR=3.04). Combining pre-and intraoperative factors, diabetes (OR=2.81), and including postoperative factors, presence of infection (OR=4.54) were predictors of prolonged hospitalization in the ward.Conclusion: Diabetes and smoking were predictors of intensive care unit outcome, and ejection fraction <50% of ward outcome. For the set of perioperative factors, prolonged hospitalization after isolated coronary artery bypass grafting was associated with mechanical ventilation >24 hours for the intensive care unit and presence of infection for the ward.Descriptors: Risk factors. Myocardial revascularization. Hospitalization. ResumoIntrodução: Características do paciente e da cirurgia de revascularização do miocárdio podem predispor à internação prolongada, aumentando custos e a morbimortalidade.Objetivo: Avaliar fatores de risco individuais e transoperató-rios para internação prolongada na unidade de terapia intensiva e na enfermaria. 354Rev Bras Cir Cardiovasc | Braz J Cardiovasc Surg Bras Cir Cardiovasc 2013;28(3):353-63 Oliveira EK, et al. -Risk factors for prolonged hospital stay after isolated coronary artery bypass grafting productivity [4,8], affecting family budgets, quality of life and increasing costs [1]. Bashour et al. [7] showed that, after cardiac surgery, many patients with prolonged hospital stay died soon after discharge and that the functional status of those who survived for a longer period was worse when compared with those who recovered faster. RevIn this context, the objective of this study was to identify pre-, intra-and postoperative risk factors for long hospitalizations in the ICU or the ward, of patients undergoing isolated CABG surgery w...

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Section: Bmi -Body Mass Index; Ef -Ejection Fraction; Oi-sc -Oxygenatsupporting

confidence: 58%

Section: Bmi -Body Mass Index; Ef -Ejection Fraction; Oi-sc -Oxygenatmentioning

confidence: 99%

Risk factors for prolonged hospital stay after isolated coronary artery bypass grafting

Oliveira¹,

Turquetto²,

Tauil³

et al. 2013

Revista Brasileira De Cirurgia Cardiovascular

View full text Add to dashboard Cite

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“…Therefore, there would be an interposition of factors associated with the trauma and the increased secretion of pro-inflammatory hormones could worsen the IR. Knapik et al [46] showed that CPB increases blood glucose levels, and promote IR in diabetic and nondiabetic patients undergoing CABG. Part of the explanation of these findings comes from the systemic Feguri GR, et al -Clinical and metabolic results of fasting abbreviation with carbohydrates in coronary artery bypass graft surgery inflammatory response syndrome (SIRS) and activation of the complement system [20].…”

Section: Discussionmentioning

confidence: 99%

Resultados clínicos e metabólicos da abreviação do jejum com carboidratos na revascularização cirúrgica do miocárdio

Feguri¹,

Lima²,

Lopes³

et al. 2012

Rev Bras Cir Cardiovasc

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“…Blood glucose level also increases in this population because of extrinsic sources including dextrose-containing fluids, corticosteroids, sympathomimetic drugs, and cardiopulmonary bypass. 2 Clinically, acute hyperglycemia is associated with increased incidence of sternal wound infections, hemodynamic instability, increased platelet aggregation, significant early morbidity, and mortality. 3 taining blood glucose levels at less than 180 mg/dL during surgery and immediately postoperatively to prevent complications, especially deep sternal wound infections.…”

Section: Background/significance Of the Problem Glycemic Control In Cmentioning

confidence: 99%

Glycemic Control in Cardiac Surgery: Implementing an Evidence-Based Insulin Infusion Protocol

Hargraves

2014

American Journal of Critical Care

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Background Acute hyperglycemia following cardiac surgery increases the risk of deep sternal wound infection, significant early morbidity, and mortality. Insulin infusion protocols that target tight glycemic control to treat hyperglycemia have been linked to hypoglycemia and increased mortality. Recently published studies examining glycemic control in critical illness and clinical practice guidelines from professional organizations support moderate glycemic control. Objectives To measure critical care nurses' knowledge of glycemic control in cardiac surgery before and after education. To evaluate the safety and effectiveness of an evidence-based insulin infusion protocol targeting moderate glycemic control in cardiac surgery patients. Methods This evidence-based practice change was implemented in the cardiovascular unit in a community teaching hospital. Nurses completed a self-developed questionnaire to measure knowledge of glycemic control. Blood glucose data, collected (retrospectively) from anesthesia end time through 11:59 PM on postoperative day 2, were compared from 2 months before to 2 months after the practice change. Results Nurses' knowledge (test scores) increased significantly after education (pretest mean = 53.10, SD = 11.75; posttest mean = 79.10, SD = 12.02; t 54 = -8.18, P < .001). Mean blood glucose level after implementation was 148 mg/dL. The incidence of hypoglycemia, 2.09% before and 0.22% after the intervention, was significantly reduced ( 2 1 [n = 29] = 13.9, P < .001). The percentage of blood glucose levels less than 180 mg/dL was 88.30%. Conclusions Increasing nurses' knowledge of glycemic control and implementing an insulin infusion protocol targeting moderate glycemic control were effective for treating acute hyperglycemia following cardiac surgery with decreased incidence of hypoglycemia.

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Cardiopulmonary Bypass Increases Postoperative Glycemia and Insulin Consumption After Coronary Surgery

Cited by 52 publications

References 29 publications

Risk factors for prolonged hospital stay after isolated coronary artery bypass grafting

Risk factors for prolonged hospital stay after isolated coronary artery bypass grafting

Resultados clínicos e metabólicos da abreviação do jejum com carboidratos na revascularização cirúrgica do miocárdio

Glycemic Control in Cardiac Surgery: Implementing an Evidence-Based Insulin Infusion Protocol

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