Safety and efficacy of intensive intraoperative glycaemic control in cardiopulmonary bypass surgery: a randomised trial

Rujirojindakul, Panthila; Liabsuetrakul, Tippawan; McNeil, Edward; Chanchayanon, Thavat; Wasinwong, Wirat; Oofuvong, Maliwan; Rergkliang, Chareonkiat; Chittithavorn, Voravit

doi:10.1111/aas.12305

Cited by 12 publications

(5 citation statements)

References 42 publications

(55 reference statements)

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“…However, the beneficial effects of tight glycemic control during cardiac surgery in patients remain questioned and controversial as conflicting reports have emerged. In contrast to aforementioned studies, other researches demonstrated that intensive blood glucose control has no effect on reducing mortality in patients with type 1 or type 2 diabetes [ 21 ] and significantly increased the risk of intraoperative hypoglycaemia without clear postoperative benefit in patients undergoing cardiac surgery using cardiopulmonary [ 22 ]. So far, to our knowledge, there is no direct evidence to explore the effects and mechanism of tight glycemic control during myocardial IRI.…”

Section: Introductionmentioning

confidence: 99%

Effects of Glucose Concentration on Propofol Cardioprotection against Myocardial Ischemia Reperfusion Injury in Isolated Rat Hearts

Yao

Tao

et al. 2015

Journal of Diabetes Research

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The anesthetic propofol confers cardioprotection against myocardial ischemia-reperfusion injury (IRI) by reducing reactive oxygen species (ROS). However, its cardioprotection on patients is inconsistent. Similarly, the beneficial effect of tight glycemic control during cardiac surgery in patients has recently been questioned. We postulated that low glucose (LG) may promote ROS formation through enhancing fatty acid (FA) oxidation and unmask propofol cardioprotection during IRI. Rat hearts were isolated and randomly assigned to be perfused with Krebs-Henseleit solution with glucose at 5.5 mM (LG) or 8 mM (G) in the absence or presence of propofol (5 μg/mL) or propofol plus trimetazidine (TMZ). Hearts were subjected to 35 minutes of ischemia followed by 60 minutes of reperfusion. Myocardial infarct size (IS) and cardiac CK-MB were significantly higher in LG than in G group (P < 0.05), associated with reduced left ventricular developed pressure and increases in postischemic cardiac contracture. Cardiac 15-F2t-isoprostane was higher, accompanied with higher cardiac lipid transporter CD36 protein expression in LG. Propofol reduced IS, improved cardiac function, and reduced CD36 in G but not in LG. TMZ facilitated propofol cardioprotection in LG. Therefore, isolated heart with low glucose lost sensitivity to propofol treatment through enhancing FA oxidation and TMZ supplementation restored the sensitivity to propofol.

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Section: Introductionmentioning

confidence: 99%

Effects of Glucose Concentration on Propofol Cardioprotection against Myocardial Ischemia Reperfusion Injury in Isolated Rat Hearts

Yao

Tao

et al. 2015

Journal of Diabetes Research

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“…Para un total de 3948 pacientes, los participantes incluidos en los estudios identificados fueron pacientes llevados a cirugía cardiaca, cirugía mayor no cardiaca, gastrectomía, injerto o derivación cardiopulmonar, cirugía que requirió uso de oxigenación por membrana extracorpórea, reparación o reemplazo valvular, cirugía electiva de arteria coronaria multivaso o cirugía de tumores malignos. En el análisis agrupado, se encontró diferencia estadísticamente significativa, a favor del control de glicemia perioperatoria, para reducir el riesgo de infección posoperatoria (RR 0.62; IC 95% 0.50 a 0.77; certeza de la evidencia alta) [202][203][204][205][206][207][208][209][210][211][212][213][214][215][216][217][218] .…”

Section: Resumen De La Evidenciaunclassified

“…También se observó un mayor riesgo, estadísticamente significativo, de eventos hipoglicémicos con el control de glicemia (22 estudios; 5665 pacientes; RR 0.04; IC 95% 0.03 a 0.06; certeza de la evidencia alta) 202,204,205,[207][208][209][210][211][215][216][217][218][219][220][221][222][223][224][226][227][228] . No se identificaron diferencias estadísticamente significativas con el control de glicemia perioperatoria frente a la atención estándar, esta última definida como una estrategia liberal o sin control de glicemia, para los desenlaces de: déficit neurológico (5 ECAs; 1726; Diferencia de riesgo -0.01; IC 95% -0.02 a -0.00; certeza de la evidencia alta) (204,206,207,220,228), y evento cerebrovascular (5 ECAs; 1521 pacientes; Diferencia de riesgo 0.02; IC 95% 0 a 0.03; certeza de la evidencia baja) 209,210,216,217,228 .…”

Section: Resumen De La Evidenciaunclassified

Guía de práctica clínica para la prevención de la infección del sitio quirúrgico

Cortés,

Valderrama-Rios,

Torregrosa-Almonacid

et al. 2023

Infect

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Las infecciones asociadas a la atención de la salud (IAAS) son el evento adverso más frecuentemente reportado en todo el mundo, siendo la infección del sitio quirúrgico (ISQ) la IAAS con mayor incidencia en los países de ingresos bajos y medios, como Colombia, con consecuencias importantes para los pacientes, la sociedad y el sistema de salud, debido al incremento en morbilidad, mortalidad y costos que genera. La presente guía contiene recomendaciones perioperatorias para la prevención de la ISQ, basadas en la evidencia, realizadas mediante el proceso de adaptación de guías de práctica clínica para el contexto colombiano.

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“…© 2020 Forum Multimedia Publishing, LLC Barcellos 2007;Ellenberger 2018;Foroughi 2012;Howell 2011;Koskenkari 2005;Koskenkari 2006;Lazar 2004;Licker 2019;Ranasinghe 2006;Roh 2015;Rujirojindakul 2014;Seied-Hosseini 2010;Smith 2002;Straus 2013;Tsang 2007;Visser 2005]. Figure 1 shows the details of the study selection process in the meta-analysis (Figure 1).…”

Section: E65mentioning

confidence: 99%

Effect of Perioperative Glucose-Insulin-Potassium Therapy in Patients Undergoing On-Pump Cardiac Surgery: A Meta-Analysis

Yang

Zhang

et al. 2020

HSF

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Objective: The role of glucose-insulin-potassium (GIK) infusion during cardiac surgery has held interest for so many years without a clear answer. The aim of this meta-analysis was to evaluate the effect of GIK therapy on outcomes in patients undergoing on-pump cardiac surgery. Methods: A comprehensive online review was performed in The Web of Science, Embase, Medline, PubMed, and The Cochrane Library databases from 2000 to 2019. Eligible studies included randomized controlled trials (RCTs) that compared GIK treatment with placebo or standard care during on-pump cardiac surgery. Risk ratios (RR) were used for binary outcomes and mean difference (MD) was used for continuous variables; both with their 95% confidence intervals (CI). Results: A total of 18 RCTs involving 2,131 patients met the inclusion criteria. Compared with the control group, the GIK treatment significantly reduced in-hospital mortality (RR = 0.56, 95% CI: 0.32–0.97; P = .04), postoperative myocardial infarctions (MI) (RR = 0.71, 95% CI: 0.56–0.91; P = .006), the use of inotropic support (RR = 0.53, 95% CI: 0.45–0.63; P < .00001), and length of stay in the intensive care unit (ICU) (MD = -0.33, 95% CI: -0.52–-0.14; P = .0007). Moreover, GIK treatment seemed to be associated with fewer postoperative atrial fibrillation (AF) (RR = 0.81, 95% CI: 0.64–1.03; P = .09). Conclusions: In patients undergoing on-pump cardiac surgery, GIK infusion has a beneficial role in mortality during hospital stay and demonstrates superior efficacy versus standard care for reduction in postoperative MI, AF, ICU length of stay as well as inotropic agent requirements.

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Safety and efficacy of intensive intraoperative glycaemic control in cardiopulmonary bypass surgery: a randomised trial

Cited by 12 publications

References 42 publications

Effects of Glucose Concentration on Propofol Cardioprotection against Myocardial Ischemia Reperfusion Injury in Isolated Rat Hearts

Effects of Glucose Concentration on Propofol Cardioprotection against Myocardial Ischemia Reperfusion Injury in Isolated Rat Hearts

Guía de práctica clínica para la prevención de la infección del sitio quirúrgico

Effect of Perioperative Glucose-Insulin-Potassium Therapy in Patients Undergoing On-Pump Cardiac Surgery: A Meta-Analysis

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