BackgroundHyperglycaemia is a common occurrence during cardiac surgery, however, there remains some uncertainty surrounding the role of tight glycaemic control (blood glucose <180 mg/dL) during and/or after surgery. The aim of this study was to systematically review the literature to determine the effects of tight versus normal glycaemic control, during and after cardiac surgery, on measures of morbidity and mortality.MethodThe literature was systematically reviewed, based on pre-determined search criteria, for clinical trials evaluating the effect of tight versus normal glycaemic control during and/or after cardiac surgery. Each paper was reviewed by two, independent reviewers and data extracted for statistical analysis. Data from identified studies was combined using meta-analysis (RevMan5®). The results are presented either as odds ratios (OR) or mean differences (MD) with 95% confidence intervals (CIs).ResultsA total of seven randomised controlled trials (RCTs) were identified in the literature, although not all trials could be used in each analysis. Tight glycaemic control reduced the incidence of early mortality (death in ICU) (OR 0.52 [95% CI 0.30, 0.91]); of post-surgical atrial fibrillation (odds ratio (OR 0.76 [95%CI 0.58, 0.99]); the use of epicardial pacing (OR 0.28 [95%CI 0.15, 0.54]); the duration of mechanical ventilation (mean difference (MD) -3.69 [95% CI -3.85, -3.54]) and length of stay in the intensive care unit (ICU) (MD -0.57 [95%CI -0.60, -0.55]) days. Measures of the time spent on mechanical ventilation (I2 94%) and time spent in ICU (I2 99%) both had high degrees of heterogeneity in the data.ConclusionThe results from this study suggest that there may be some benefit to tight glycaemic control during and after cardiac surgery. However, due to the limited number of studies available and the significant variability in glucose levels; period of control; and the reporting of outcome measures, further research needs to be done to provide a definitive answer on the benefits of tight glycaemic control for cardiac surgery patients.
The discrepancy between the presence of necrosis and the occurrence of MOF favors association but not cause in AP. A complex, systems-based, pleiotropic inflammatory network with a common root, in which the extent of pancreatic necrosis influences the severity of MOF in certain individuals and MOF exacerbates the development of pancreatic necrosis in others, seems more likely.
There was a significant reduction in heparin concentration over the course of CPB as measured by anti-Xa assay, culminating in heparin levels at 120 min that may be considered inadequate. The ACT steadily increased over the course of CPB, probably reflecting extreme haemodilution and possibly consumption of haemostatic factors due to inadequate heparinisation. Further studies are required to determine whether maintaining the plasma heparin concentration between 4 and 5 iu.ml )1 is easily achievable and confers clinical benefit to neonates undergoing cardiopulmonary bypass.The efficacy and safety of tight blood glucose control during heart surgery: a systematic review and meta-analysis Tight blood glucose control in critical care has been associated with improved outcomes but may result in more episodes of hypoglycaemia [1]. The aim of this study was to review systematically the literature to determine the efficacy and safety of tight blood glucose control during heart surgery. MethodsA literature search of the major databases was performed and the reference lists of identified papers were hand searched. Identified studies were critically appraised. Inclusion criteria were randomised controlled trials (RCTs), patients undergoing heart surgery and explicit definitions of 'tight' and 'normal' control of blood glucose. ResultsNine of the 51 identified RCTs met the entry criteria and only four outcomes were suitable for meta-analyses. Tight blood glucose control reduced the incidences of atrial fibrillation ) and the use of epicardial pacing (OR 0.32 (95% CI 0.17-0.60)), as well as reducing the duration of mechanical ventilation (mean difference )0.36 (95% CI )3.85 to )3.54)) h and stay in the ICU (mean difference )0.57 (95% CI )0.60 to )0.55)) days. Heterogeneity was high for the incidences of atrial fibrillation (I 2 55%) and pacing (I 2 75%) and extremely high for the duration of mechanical ventilation (I 2 94%) and ICU stay (I 2 99%). Only one of nine studies found 'tight' blood glucose control to be associated with significantly more episodes of hypoglycaemia.
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