Intensive Intraoperative Insulin Therapy versus Conventional Glucose Management during Cardiac Surgery
Authors: George Carvalho, Thomas Schricker
Journal: Annals of Internal Medicine (2007)

Letters2 October 2007Intensive Intraoperative Insulin Therapy versus Conventional Glucose Management during Cardiac SurgeryGeorge Carvalho, MD and Thomas Schricker, MD, PhDGeorge Carvalho, MDFrom McGill University, Montréal, Québec H3A 1A1, Canada.Search for more papers by this author and Thomas Schricker, MD, PhDFrom McGill University, Montréal, Québec H3A 1A1, Canada.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-147-7-200710020-00016 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Gandhi and colleagues (1) report the results of a randomized, controlled trial on the effect of intensive intraoperative insulin therapy after on-pump cardiac surgery. The authors conclude that the application of an insulin sliding scale that fails to consistently maintain blood glucose levels between 4.4 and 5.6 mmol/L (80 and 100 mg/dL) does not reduce mortality or morbidity in nondiabetic and diabetic patients after a variety of cardiac procedures. An increased incidence of death and stroke in the treatment group prompted the authors to caution against the routine use of insulin therapy during cardiac surgery.Several aspects ...References1. Gandhi GY, Nuttall GA, Abel MD, Mullany CJ, Schaff HV, O'Brien PC, et al. Intensive intraoperative insulin therapy versus conventional glucose management during cardiac surgery: a randomized trial. Ann Intern Med. 2007;146:233-43. [PMID: 17310047] LinkGoogle Scholar2. van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, et al. Intensive insulin therapy in critically ill patients. N Engl J Med. 2001;345:1359-67. [PMID: 11794168] CrossrefMedlineGoogle Scholar3. Bridges CR, O'Brien SM, Cleveland JC, Savage EB, Gammie JS, Edwards FH, et al. Association between indices of prosthesis internal orifice size and operative mortality after isolated aortic valve replacement. J Thorac Cardiovasc Surg. 2007;133:1012-21. [PMID: 17382644] CrossrefMedlineGoogle Scholar4. Van den Berghe G. Does tight blood glucose control during cardiac surgery improve patient outcome? [Editorial]. Ann Intern Med. 2007;146:307-8. [PMID: 17310055] LinkGoogle Scholar5. Djaiani GN. Aortic arch atheroma: stroke reduction in cardiac surgical patients. Semin Cardiothorac Vasc Anesth. 2006;10:143-57. [PMID: 16959741] CrossrefMedlineGoogle Scholar6. Cheung NW, Napier B, Zaccaria C, Fletcher JP. Hyperglycemia is associated with adverse outcomes in patients receiving total parenteral nutrition. Diabetes Care. 2005;28:2367-71. [PMID: 16186264] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: George Carvalho, MD; Thomas Schricker, MD, PhDAffiliations: From McGill University, Montréal, Québec H3A 1A1, Canada. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoIntensive Intraoperative Insulin Therapy versus Conventional Glucose Management during Cardiac Surgery Gunjan Y. Gandhi , Gregory A. Nuttall , Martin D. Abel , Charles J. Mullany , Hartzell V. Schaff , Peter C. O'Brien , Matthew G. Johnson , Arthur R. Williams , Susanne M. Cutshall , Lisa M. Mundy , Robert A. Rizza , and M. Molly McMahon Intensive Intraoperative Insulin Therapy versus Conventional Glucose Management during Cardiac Surgery Ragheb Assaly and Robert H. Habib Intensive Intraoperative Insulin Therapy versus Conventional Glucose Management during Cardiac Surgery Ferran Rius and Didac Mauricio Intensive Intraoperative Insulin Therapy versus Conventional Glucose Management during Cardiac Surgery Gunjan Y. Gandhi , Gregory A. Nuttall , and Martin D. Abel Metrics 2 October 2007Volume 147, Issue 7Page: 520-521KeywordsAnestheticsBloodCardiac surgeryGlucoseHyperglycemiaInsulinMortalityNutritionOpen heart surgeryStroke ePublished: 2 October 2007 Issue Published: 2 October 2007 Copyright & PermissionsCopyright © 2007 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...