Document Detail


Perioperative glycemic control: an evidence-based review.
MedLine Citation:
PMID:  19194167     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Hyperglycemia in perioperative patients has been identified as a risk factor for morbidity and mortality. Intensive insulin therapy (IIT) has been shown to reduce morbidity and mortality among the critically ill, decrease infection rates and improve survival after cardiac surgery, and improve outcomes in acute neurologic injury and acute myocardial infarction. However, recent evidence of severe hypoglycemia and adverse events associated with IIT brings its safety and efficacy into question. In this article, we summarize the mechanisms and rationale of hyperglycemia and IIT, review the evidence behind the use of IIT in the perioperative period, and discuss the implications of including glycemic control in national quality benchmarks. We conclude that while avoidance of hyperglycemia is clearly beneficial, the appropriate glucose target and specific subpopulations who might benefit from IIT have yet to be identified. Given the potential for harm, inclusion of glucose targets in national quality benchmarks is premature.
Authors:
Angela K M Lipshutz; Michael A Gropper
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Publication Detail:
Type:  Journal Article; Multicenter Study; Review    
Journal Detail:
Title:  Anesthesiology     Volume:  110     ISSN:  1528-1175     ISO Abbreviation:  Anesthesiology     Publication Date:  2009 Feb 
Date Detail:
Created Date:  2009-02-05     Completed Date:  2009-03-05     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  408-21     Citation Subset:  AIM; IM    
Affiliation:
Department of Medicine, Stanford University Medical Center, USA.
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MeSH Terms
Descriptor/Qualifier:
Blood Glucose / analysis,  metabolism*
Cost-Benefit Analysis
Critical Illness
Humans
Hyperglycemia / blood,  physiopathology,  prevention & control*
Hypoglycemic Agents / therapeutic use
Insulin / therapeutic use
Intensive Care
Intraoperative Complications / mortality,  prevention & control
Perioperative Care*
Postoperative Complications / mortality,  prevention & control
Risk Factors
Chemical
Reg. No./Substance:
0/Blood Glucose; 0/Hypoglycemic Agents; 11061-68-0/Insulin
Comments/Corrections
Comment In:
Anesthesiology. 2009 Feb;110(2):204-6   [PMID:  19194142 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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