Glicose insulina e potássio (GIK) na revascularização do miocárdio de pacientes diabéticos: ensaio clínico randomizado

Barcellos, Christiano; Wender, Orlando Carlos Belmonte; Azambuja, Paulo C.

doi:10.1590/s0102-76382007000300002

Cited by 14 publications

(5 citation statements)

References 29 publications

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“…Furthermore, we discontinued the insulin-glucose infusion upon completion of surgery whereas the HINGE trial and others 9,12,13,36 continued GIK until 6 hours after reperfusion. Other investigations though, 37 reported no reduction in myocardial enzyme release with GIK infusions extending 12 or more hours postoperatively, suggesting that a longer duration of insulin administration may not have substantively altered our results. Finally, we compared within-patient changes in myocardial strain and strain rate, a sensitive study design since patients served as their own controls.…”

Section: Discussioncontrasting

confidence: 59%

Hyperinsulinemic Normoglycemia Does Not Meaningfully Improve Myocardial Performance during Cardiac Surgery

et al. 2015

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Background Glucose-insulin-potassium (GIK) administration during cardiac surgery inconsistently improves myocardial function, perhaps because hyperglycemia negates the beneficial effects of GIK. The hyperinsulinemic normoglycemic clamp (HNC) technique may better enhance the myocardial benefits of GIK. We extended previous GIK investigations by: 1) targeting normoglycemia while administering a glucose-insulin-potassium infusion (HNC); 2) using improved echocardiographic measures of myocardial deformation, specifically myocardial longitudinal strain and strain rate; and, 3) assessing activation of glucose metabolic pathways. Methods 100 patients having aortic valve replacement for aortic stenosis were randomly assigned to HNC (high-dose insulin with concomitant glucose infusion titrated to normoglycemia) versus standard therapy (insulin treatment if glucose >150 mg/dL). Our primary outcomes were left ventricular longitudinal strain and strain rate, assessed using speckle-tracking echocardiography. Right atrial tissue was analyzed for activation of glycolysis/pyruvate oxidation and alternative metabolic pathways. Results Time-weighted mean glucose concentrations were lower with HNC (127±19 mg/dL) than standard care (177±41 mg/dL; P<0.001). Echocardiographic data were adequate in 72 patients for strain analysis and 67 patients for strain rate analysis. HNC did not improve myocardial strain, with an HNC minus standard therapy difference of −1.2 (97.5%CI: −2.9, 0.5)%; P=0.11. Strain rate was significantly better, but by a clinically unimportant amount: −0.16 (−0.30, −0.03) sec−1, P = 0.007. There was no evidence of increased glycolytic, pyruvate oxidation, or hexosamine biosynthetic pathway activation in right atrial samples (n = 20, HNC; 22, standard therapy). Conclusions Administration of glucose and insulin while targeting normoglycemia during aortic valve replacement did not meaningfully improve myocardial function.

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Section: Discussioncontrasting

confidence: 59%

Hyperinsulinemic Normoglycemia Does Not Meaningfully Improve Myocardial Performance during Cardiac Surgery

et al. 2015

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“…These protocols included the administration of intravenous insulin and were aimed at obtaining perioperative blood glucose values below 200 mg/dL. The reduction in the rate of surgical site infections obtained was from 90% [19] to 50% [18,20]. However, the risk of hypoglycemia was not well described in these studies.…”

Section: Discussionmentioning

confidence: 99%

“…Most studies have evaluated the safety and efficacy of tight blood glucose control in patients with diabetes undergoing coronary artery bypass graft surgery [17][18][19][20]. These protocols included the administration of intravenous insulin and were aimed at obtaining perioperative blood glucose values below 200 mg/dL.…”

Section: Discussionmentioning

confidence: 99%

Effect of a program to control perioperative blood glucose on the incidence of nosocomial infections in patients with diabetes: A pilot study

Ena¹,

Casañ²,

Carratalá³

et al. 2012

JDM

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Aim: To evaluate the safety and effectiveness of a pilot program to control perioperative blood glucose in patients with diabetes. Methods: A pre-post intervention study was conducted in a 280-bed hospital in Spain. In the year 2008 we implemented perioperative insulin protocols aimed at blood glucose values from 80 to 180 mg/dL. Surgical patients with diabetes admitted on year 2009 (intervention group) were compared with a control group of patients with diabetes admitted for surgery on year 2007, matched 1:1 by traditional wound class. Results: We analyzed 96 patients. Implemented protocols were followed in 48% of patients intra-operatively and 75% of patients postoperatively. Patients in the intervention group had reductions in blood glucose at surgery 150 +/- 61 mg/dL vs. 172 +/- 53 mg/dL; p = 0.05), greater proportion of target glucose values throughout hospitalization (67% vs. 55%; p = 0.07), and reductions in the incidence of nosocomial infections after controlling for confounders (Odds Ratio: 0.20; 95% Confidence intervals: 0.06 - 0.72; p = 0.014) when they were compared with the control group: The incidence of hypoglycemia was similar between two groups (0.12% vs. 0.10%, p = 0.867), respectively. Conclusion: Although our protocol needs improvements to increase implementation it was useful to control blood glucose safely and for reducing nosocomial infections

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“…Different studies have focused on surgery complication and most of them demonstrated more prevalent surgery site infections ( 6 , 7 ). According to researchers, tight control of glucose in patients with DM is beneficial in reducing postoperation complications; however, the adequate range has not yet been defined ( 8 , 9 ). Van den Berghe et al have demonstrated that insulin infusion during surgery can maintain the glucose level between 80 to 110 mg/dL ( 10 ).…”

Section: Introductionmentioning

confidence: 99%

Insulin infusion on postoperative complications of coronary artery bypass graft in patients with diabetes mellitus

Masoumi¹,

Frasatkhish²,

Bigdelian³

et al. 2014

Res Cardiovasc Med

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Background:Cardiovascular events are common in patients with diabetes mellitus (DM), which make coronary artery bypass graft (CABG) a highly demanded surgery in this population. Tight control of blood glucose in patients with DM is beneficial in reducing postoperative complications; however, the adequate range has not been determined yet.Objectives:This study aimed to investigate the effect of semi-tight (moderate) control of DM on complications and serum glucose levels during and after CABG.Patients and Methods:In this prospective clinical trial, 18 and 31 patients with and without DM, respectively, who were referred to Shahid Chamran Hospital, Isfahan, Iran, for elective CABG surgery, were enrolled. For DM group, patients with controlled DM (i.e. glycosylated hemoglobin levels [HgA1C] ≤ 7%) were recruited. Blood glucose level (blood sugar, BS) was measured after anesthesia, during pumping, warming, off pumping, six and 12 hours after Intensive Care Unit (ICU) admission, and at discharging from the hospital. The hemodynamic state of the patients, bleeding, need of blood transfusion, infection, and duration of hospitalization were also monitored and recorded.Results:None of the BS measurements (FBS, after anesthesia, on-pump, warming, off pump, six and 12 hours after ICU admission, and at discharge) were significantly different between study groups (P > 0.05). Frequency of surgery site bleeding and blood transfusion need were not significantly different between these groups (P > 0.05).Conclusions:Semi-tight control of DM with insulin infusion during operation did not led to any difference in the type and rate of CABG complications between patients with well-controlled and those without DM; however, BS levels in patients with well-controlled DM could be more easily controlled.

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Glicose insulina e potássio (GIK) na revascularização do miocárdio de pacientes diabéticos: ensaio clínico randomizado

Cited by 14 publications

References 29 publications

Hyperinsulinemic Normoglycemia Does Not Meaningfully Improve Myocardial Performance during Cardiac Surgery

Hyperinsulinemic Normoglycemia Does Not Meaningfully Improve Myocardial Performance during Cardiac Surgery

Effect of a program to control perioperative blood glucose on the incidence of nosocomial infections in patients with diabetes: A pilot study

Insulin infusion on postoperative complications of coronary artery bypass graft in patients with diabetes mellitus

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