Disturbance of Glucose Homeostasis After Pediatric Cardiac Surgery

Abstract

This study aimed to evaluate the time course of perioperative blood glucose levels of children undergoing cardiac surgery for congenital heart disease in relation to endogenous stress hormones, inflammatory mediators, and exogenous factors such as caloric intake and glucocorticoid use. The study prospectively included 49 children undergoing cardiac surgery. Blood glucose levels, hormonal alterations, and inflammatory responses were investigated before and at the end of surgery, then 12 and 24 h afterward. In general, blood glucose levels were highest at the end of surgery. Hyperglycemia, defined as a glucose level higher than 8.3 mmol/l (>150 mg/dl) was present in 52% of the children at the end of surgery. Spontaneous normalization of blood glucose occurred in 94% of the children within 24 h. During surgery, glucocorticoids were administered to 65% of the children, and this was the main factor associated with hyperglycemia at the end of surgery (determined by univariate analysis of variance). Hyperglycemia disappeared spontaneously without insulin therapy after 12–24 h for the majority of the children. Postoperative morbidity was low in the study group, so the presumed positive effects of glucocorticoids seemed to outweigh the adverse effects of iatrogenic hyperglycemia.

Insulin resistance and inflammation are a cause of hyperglycemia after pediatric cardiopulmonary bypass surgery

“…22 Of the 52% of subjects who experienced postoperative hyperglycemia, only 9% were found to have an insulin-to-glucose ratio >18, marking the limit of insulin resistance; however, blood sugar in all subjects had normalized by the end of the study period. Plasma insulin concentration rose sharply after CPB and remained elevated throughout the study.…”

“…22 The incidence of postoperative hyperglycemia was high, with 85% of subjects having !1 elevated measurement during the period of observation. The time course of hyperglycemia was similar, with peak odds of hyperglycemia and highest mean glucose concentration occurring at 6 hours after surgery.…”

“…The inverse ratio-of insulin to glucose-has in fact been used in several studies exploring CIH in children. [21][22][23] The insulin-to-glucose ratio was used to examine the CIH occurring during respiratory failure 21 and after pediatric CPB surgery 22,23 ; the glucoseto-insulin ratio was therefore chosen as the marker of insulin resistance for this study.…”

Faktor yang Berhubungan dengan Hiperglikemia dan Luarannya pada Anak Sakit Kritis

“…16 Belum ada kriteria pasti untuk mendiagnosis hiperglikemia pada pasien non-diabetes mellitus. Preissig dkk 17 melakukan survei di 30 PICU, ditunjukkan bahwa sebagian besar dokter anak (>50%) menentukan nilai cut-off glukosa darah antara 140 sampai 160 mg/ dL.…”

“…30 Skor PELOD hanya dilakukan satu kali yaitu saat masuk PICU. Leteurtre dkk 30 membagi skor PELOD yang dilakukan pada hari pertama menjadi 3 kelompok, yaitu rendah (< 10), sedang (10)(11)(12)(13)(14)(15)(16)(17)(18)(19), dan tinggi (>20), dengan nilai cut-off 10 dan 20 berhubungan dengan peningkatan mortalitas. Kami juga menggunakan nilai cut-off skor PELOD 20 dan didapatkan 10 subjek yang memiliki nilai PELOD >20.…”