Impaired Postoperative Hyperglycemic Stress Response Associated with Increased Mortality in Patients in the Cardiothoracic Surgery Intensive Care Unit |
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| Affiliation: | 1. Division of Endocrinology and Metabolism, Albert Einstein College of Medicine, Beth, Israel, Medical Center, New York, New York;2. Cardiothoracic Surgical Intensive Care Unit, New York, New York;3. Department of Cardiothoracic Surgery, New York, New York;4. Medical School, New York, New York;5. Division of Endocrinology, Diabetes, and Bone Disease, Mount Sinai School of Medicine, New York, New York.;1. Department of Internal Medicine and Physiology;2. Department of Human Nutritional Sciences;3. Department of Food Sciences, University of Winnipeg, Manitoba, Canada;4. Xiangya Boai Rehabilitation Hospital, Changsha, Hunan, China;1. Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran;2. Department of pathology, Mirza Kuchikkhan Hospital, Tehran University of Medical Sciences, Tehran, Iran |
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| Abstract: | ObjectiveTo describe the association of tight glycemic control with intensive insulin therapy and clinical outcome among patients in the cardiothoracic surgery intensive care unit.MethodsAll patients who underwent cardiothoracic surgery and were admitted to the cardiothoracic surgery intensive care unit between September 13, 2007, and November 1, 2007, were enrolled. Clinical and metabolic data were prospectively collected. All patients received intensive insulin therapy using a nurse-driven dynamic protocol targeting blood glucose values of 80 to 110 mg/dL. Four stages of critical illness were defined as follows: acute critical illness (intensive care unit days 0-2), prolonged acute critical illness (intensive care unit 3 or more days), chronic critical illnesss (tracheotomy performed), and recovery (liberated from ventilator).ResultsOne hundred fourteen patients were enrolled. Seventy-three (64%) recovered during acute critical illness, 26 (23%) recovered during prolonged acute critical illness, and 15 (13%) progressed to chronic critical illness. All 6 deaths were among patients in chronic critial illness. Admission blood glucose and average blood glucose values for the first 12 hours were lower in patients who developed chronic critical illness and died and were higher in patients who developed chronic critical illness and survived (P = .007 and P = .007, respectively). Severe hypoglycemia (blood glucose < 40 mg/dL) occurred once (0.03% of all measurements). Lower initial blood glucose values, which reflect an impaired stress response immediately after surgery, were associated with increased mortality, and a significant delay in achieving tight glycemic control with intensive insulin therapy was associated with prolonged intensive care unit course, but no increase in mortality.ConclusionThe study findings suggest that acute postoperative hyperglycemia and its prompt correction with intensive insulin therapy are associated with favorable outcomes in patients in the cardiothoracic surgery intensive care unit. (Endocr Pract. 2010;16:798-804) |
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