Reference
The Society of Thoracic Surgeons Practice Guideline Series: Blood Glucose Management During Adult Cardiac Surgery
Lazar LH, McDonnell M, Chipkin SR, Furnary AP, Engelman RM et al
Ann Thor Surg 2009; 87: 663-9
Comment
This Report from the STS Workforce on Evidence-Based Medicine is a summary of guidelines for the management of hyperglycemia in both patients with and without diabetes undergoing cardiac surgical procedures It was derived from evidence-based recommendations using the ACC/AHA methodology.
Three key points that form the basis of the article are identified with a review of the studies to provide the evidence. Next, a series of recommendations is issued, divided into six categories, with mention of the class and level of evidence.
The authors conclude that important issues need to be elucidated and further studies need to determine:
- the optimal level of glycemic control and which, if any, specific time in the perioperative period is most crucial for maintaining glycemic control
- whether the level of glucose achieved is as important as the amount of insulin delivered
- the importance of preoperative HbA1c levels and whether surgery should be delayed in patients with higher values
Keypoints
- Poor perioperative glycemic control is associated with increased morbidity and mortality
- Glycemic control in patients with diabetes during cardiac surgery:
° reduces mortality
° reduces morbidity
° lowers the incidence of wound infections
° reduces hospital length of stay
° enhances long-term survival- Intraoperative glycemic control using intravenous insulin is not necessary in cardiac surgery patients without diabetes provided that glucose values remain < 180 mg/dL
Recommendation
