Thursday, February 25, 2010

Glycemic control in cardiac surgery patients

Recent evidence has been disappointing concerning tight glycemic control in the general critically ill population, and the suggested threshold for intervention is now 180mg/dl. Different considerations may apply in special populations, and for cardiac surgery patients the target is unclear. A new literature review of glycemic control post cardiac surgery, published in the Baylor University Medical Center Proceedings, concluded thusly:

Based on recent information, the new Society of Thoracic Surgeons guidelines and the AACE/ADA consensus statement seem appropriate and allay the concern for hypoglycemia with the new recommended range of less than180 and 140 to 180 mg/dL. More studies analyzing blood glucose target ranges seem necessary to further recommend an intensive blood glucose goal range of 80 to 110 mg/dL, especially in the cardiac surgery population. Even throughout the Van Den Berghe trials, the average blood sugar of patients in the intensive control arm was approximately 140 mg/dL. Thus, aiming for blood glucose levels around 140 mg/dL appears reasonable. Mortality and morbidity benefits are seen with overall control of hyperglycemia; however, the exact range is still not clearly defined, as previously thought.

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