Impact of hyperglycemia on perioperative mortality after coronary artery bypass graft surgery

Székely, Andrea; Levin, Jack; Miao, Yinghui; Tudor, Iulia Cristina; Vuylsteke, Alain; Ofner, Péter; Mangano, Dennis T.

doi:10.1016/j.jtcvs.2011.03.009

Cited by 45 publications

(35 citation statements)

References 27 publications

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“…The current study reported the same outcome, that the use of dexmedetomidine decreases the risk of hyperglycemia after cardiac surgery. Since postoperative hyperglycemia is associated with increased in-hospital mortality in non-diabetic patients after cardiac surgery [33,34], this property may help the clinicians to better control plasma glucose levels after surgery.…”

Section: Discussionmentioning

confidence: 99%

Can dexmedetomidine be a safe and efficacious sedative agent in post-cardiac surgery patients? a meta-analysis

Lin

Chen

et al. 2012

Crit Care

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IntroductionThe aim of this study was to explore the use of dexmedetomidine as a safe and efficacious sedative agent in post-cardiac surgery patients.MethodsA systematic literature search of MEDLINE, EMBASE, the Cochrane Library and Science Citation Index until January 2012 and review of studies was conducted. Eligible studies were of randomized controlled trials or cohort studies, comparing dexmedetomidine with a placebo or an alternative sedative agent in elective cardiac surgery, using dexmedetomidine for postoperative sedation and available in full text. Two reviewers independently performed study selection, quality assessment, and data extraction.ResultsThe search identified 530 potentially relevant publications; 11 met selection criteria in this meta-analysis. Our results revealed that dexmedetomidine was associated with a shorter length of mechanical ventilation (mean difference -2.70 [-5.05, -0.35]), a lower risk of delirium (risk ratio 0.36 [0.21, 0.64]), ventricular tachycardia (risk ratio 0.27 [0.08, 0.97]) and hyperglycemia (risk ratio 0.78 [0.61, 0.99]), but may increase the risk of bradycardia (risk ratio 2.08 [1.16, 3.74]). But there was no significant difference in ICU stay, hospital stay, and morphine equivalents between the included studies. Dexmedetomidine may not increase the risk of hypotension, atrial fibrillation, postoperative nausea and vomiting, reintubation within 5 days, cardiovascular complications, postoperative infection or hospital mortality.ConclusionsDexmedetomidine was associated with shorter length of mechanical ventilation and lower risk of delirium following cardiac surgery. Although the risk of bradycardia was significantly higher compared with traditional sedatives, it may not increase length of hospital stay and hospital mortality. Moreover, dexmedetomidine may decrease the risk of ventricular tachycardia and hyperglycemia. Thus, dexmedetomidine could be a safe and efficacious sedative agent in cardiac surgical patients.

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Section: Discussionmentioning

confidence: 99%

Can dexmedetomidine be a safe and efficacious sedative agent in post-cardiac surgery patients? a meta-analysis

Lin

Chen

et al. 2012

Crit Care

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“…These patients may exhibit abnormal glucose levels only in the perioperative period. Previous studies have shown that nondiabetic patients with glucose levels >250 mg/dL who did not receive insulin therapy have increased hospital mortality [50]. Hence, as is discussed below, it is important that all cardiac surgical patients with elevated perioperative glucose values be treated with continuos insulin infusions, irregardless of whether a preoperative diagnosis of diabetes has or has not been established.…”

Section: The Role Of Tight Glycemic Control In Nondiabetic Cabg Pamentioning

confidence: 99%

Glycemic Control during Coronary Artery Bypass Graft Surgery

Lazar

2012

ISRN Cardiology

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Hyperglycemia, which occurs in the perioperative period during cardiac surgery, has been shown to be associated with increased morbidity and mortality. The management of perioperative hyperglycemia during coronary artery bypass graft surgery and all cardiac surgical procedures has been the focus of intensive study in recent years. This report will paper the pathophysiology responsible for the detrimental effects of perioperative hyperglycemia during cardiac surgery, show how continuous insulin infusions in the perioperative period have improved outcomes, and discuss the results of trials designed to determine what level of a glycemic control is necessary to achieve optimal clinical outcomes.

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“…Hyperglycemia affects the clinical outcomes after cardiac surgery. [ 3 4 5 6 7 8 9 10 11 12 13 ] Therefore, it is desirable to control hyperglycemia to improve prognosis. However, the risk of hypoglycemia becomes a limiting factor.…”

Section: Introductionmentioning

confidence: 99%

Feasibility, efficacy, and safety of a simple insulin infusion protocol in a large volume cardiac surgery unit in India

Bansal

Mithal

Carvalho³

et al. 2015

Indian J Endocr Metab

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Aim:Inpatient hyperglycemia management is essential, but difficult to achieve especially in a large volume cardiac surgery setup, thus necessitating use of nurse-led insulin protocols. A rapid flux of nurses dealing with a huge workload has been a cause for traditionally not using nurse-led protocols in most Indian institutes. The challenges we faced were to have a simple protocol for the nurses to accept it without compromising on glycemic control. Therefore, this observational study was planned to measure the efficacy and safety of the insulin infusion protocol in cardiac surgery patients.Materials and Methods:Insulin protocol was implemented, using seven fixed columns of infusion with the nurse making decisions to initiate and titrate doses based on simple rules. Blood glucose (BG) data captured from blood gas analyzers (glucometrics) in the intervention group (i.e., after protocol implementation) were compared to control group (i.e., before the protocol implementation).Results:The mean BG for the first 48 h was lower in the intervention group as compared to control group, without an increase in the episodes of hypoglycemia. The nurses found the protocol easy to understand, less time-consuming and there was no protocol deviation over 8 months after implementation.Conclusion:A small change in the process, allowing nurses to titrate insulin doses based on some rules and having seven fixed columns of insulin infusion rates, improved glycemic control and efficiency.

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Impact of hyperglycemia on perioperative mortality after coronary artery bypass graft surgery

Abstract: Postoperative hyperglycemia is associated with increased in-hospital mortality in nondiabetic patients after coronary artery bypass graft surgery. In diabetic patients, hyperglycemia was not associated with mortality.

Cited by 45 publications

References 27 publications

Can dexmedetomidine be a safe and efficacious sedative agent in post-cardiac surgery patients? a meta-analysis

Can dexmedetomidine be a safe and efficacious sedative agent in post-cardiac surgery patients? a meta-analysis

Glycemic Control during Coronary Artery Bypass Graft Surgery

Feasibility, efficacy, and safety of a simple insulin infusion protocol in a large volume cardiac surgery unit in India

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