Efficacy and safety of an insulin infusion protocol during and after cardiac surgery
| Autor: | C. Studer, W. Sankou, Alfred Penfornis, Marc Puyraveau, Emmanuel Samain, A. Cordier, Joseph-Philippe Etievent, Sebastien Pili-Floury |
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| Přispěvatelé: | Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Service de Diabétologie - Endocrinologie [CHRU Besançon], Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( EA 3920) (PCVP / CARDIO), Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Hôpital Jean Minjoz, Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ), Service de diabétologie - endocrinologie, Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Hôpital Jean Minjoz, Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( PCVP / CARDIO ), Université Bourgogne Franche-Comté ( UBFC ) -Université de Franche-Comté ( UFC ) -Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) |
| Rok vydání: | 2010 |
| Předmět: |
Blood Glucose
Male MESH: Hypoglycemia MESH : Insulin Endocrinology Diabetes and Metabolism medicine.medical_treatment MESH : Aged Aorta Thoracic 030204 cardiovascular system & hematology law.invention Intraoperative Period 0302 clinical medicine Endocrinology MESH: Postoperative Period law Insulin MESH : Female Postoperative Period 030212 general & internal medicine Coronary Artery Bypass Infusions Intravenous Prospective cohort study MESH: Aged MESH: Middle Aged MESH: Cardiac Surgical Procedures MESH : Vascular Surgical Procedures MESH : Infusions Intravenous General Medicine [ SDV.MHEP.CSC ] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system Middle Aged Intensive care unit 3. Good health Cardiac surgery MESH : Intraoperative Period Female Safety Vascular Surgical Procedures medicine.medical_specialty MESH : Male MESH: Aorta Thoracic MESH : Drug Administration Schedule MESH: Monitoring Intraoperative MESH: Insulin MESH: Drug Administration Schedule Hypoglycemia MESH : Cardiac Surgical Procedures Drug Administration Schedule 03 medical and health sciences [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system MESH: Hypoglycemic Agents Monitoring Intraoperative Diabetes mellitus Internal Medicine medicine Humans Hypoglycemic Agents MESH : Middle Aged MESH : Safety Cardiac Surgical Procedures MESH: Infusions Intravenous MESH: Vascular Surgical Procedures Pancreatic hormone MESH : Aorta Thoracic Aged MESH : Postoperative Period MESH: Intraoperative Period MESH: Humans MESH : Hypoglycemia business.industry MESH: Coronary Artery Bypass MESH : Humans MESH: Safety Perioperative MESH : Blood Glucose medicine.disease MESH : Hypoglycemic Agents MESH : Coronary Artery Bypass MESH: Male Surgery Hyperglycemia MESH : Hyperglycemia MESH: Blood Glucose MESH : Monitoring Intraoperative MESH: Hyperglycemia business MESH: Female |
| Zdroj: | Diabetes and Metabolism Diabetes and Metabolism, Elsevier Masson, 2010, 36 (1), pp.71-8. ⟨10.1016/j.diabet.2009.05.008⟩ Diabetes and Metabolism, Elsevier Masson, 2010, 36 (1), pp.71-8. 〈10.1016/j.diabet.2009.05.008〉 |
| ISSN: | 1262-3636 |
| DOI: | 10.1016/j.diabet.2009.05.008 |
| Popis: | International audience; AIM: Perioperative tight blood glucose (BG) control using insulin therapy after major surgery is a difficult, time-consuming task that also raises some concerns over the risk of severe hypoglycaemia. The aim of the present prospective study was to evaluate the efficacy and safety of an insulin therapy protocol in use at our institution. METHODS: A total of 230 consecutive patients (mean+/-SD age: 67+/-11 years; diabetic patients: n=62) undergoing cardiac surgery (coronary artery bypass grafting: n=137; 20% off-pump) or intrathoracic aortic (n=10) surgery were included. BG control was managed according to an insulin therapy protocol, described by Goldberg et al. (2004) [11], in use for 6 months in our intensive care unit. Insulin infusion rate and frequency of BG monitoring were both adjusted according to: (1) the current BG value; (2) the previous BG value; and (3) the current insulin infusion rate. Efficacy was assessed by the percentage of time spent at the target BG level (100-139 mg/dL) intraoperatively and during the first 2 postoperative days (POD). RESULTS: All patients received postoperative insulin therapy. Patients spent 57.3% and 69.7% of time within the BG target range on POD 1 and 2, respectively. The percentage of time was significantly higher in nondiabetics than in diabetics. Mean BG measurements per patient intraoperatively, on POD 1 and on POD 2 were 4+/-1, 10+/-2 and 7+/-2, respectively. No patient experienced any severe hypoglycaemic events (BG |
| Databáze: | OpenAIRE |
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