Prognostic significance of glycemic variability after cardiac surgery

Cardiac and Vascular Surgery–Associated Acute Kidney Injury: The 20th International Consensus Conference of the ADQI (Acute Disease Quality Initiative) Group

“…[114][115][116] Moderate glucose control (127-179 mg/dL) was found in a randomized controlled trial (RCT) to be preferable to tight control (≤126 mg/dL) in patients undergoing coronary artery bypass grafting, 117 resulting in lower rates of AKI and mortality, with the most important factor being avoidance of glucose variability throughout the entire perioperative time frame. 118,119 The use of balanced crystalloid solutions guided by measures of fluid responsiveness is supported by the current literature and is consistent with the recommendations for fluid management in critically ill patients with sepsis. 97,[120][121][122][123] The administration of hydroxyethyl starch is not indicated for patients at risk of CS-AKI because of its demonstrated renal toxicity.…”

“…A possible exception is dexmedetomidine, for which a number of small or low‐quality studies found a reduction in the occurrence of AKI after cardiac surgery . Moderate glucose control (127–179 mg/dL) was found in a randomized controlled trial (RCT) to be preferable to tight control (≤126 mg/dL) in patients undergoing coronary artery bypass grafting, resulting in lower rates of AKI and mortality, with the most important factor being avoidance of glucose variability throughout the entire perioperative time frame . The use of balanced crystalloid solutions guided by measures of fluid responsiveness is supported by the current literature and is consistent with the recommendations for fluid management in critically ill patients with sepsis .…”

Association Between Glucose Variability And Postoperative Delirium In Acute Aortic Dissection Patients: An Observational Study

“…Compared with hyperglycemia, blood GV better re ects changes in the condition and has greater adverse effects on the body, which may have higher clinical value 10,11 . It is well known that blood GV increases the risk of adverse events after cardiac surgery, such as acute kidney injury, and the risk of short-term and long-term death 12,13 . At present, only one article has pointed out that hypoglycemia is positively correlated with delirium in mixed ICU diabetic patients, but high blood GV is not correlated with delirium 14 .…”

Intraoperative glucose variability, but not average glucose concentration, may be a risk factor for acute kidney injury after cardiac surgery: a retrospective study

“…Fourth, the effect of immediate postoperative glucose control was not analyzed in the study. Given the potential significant effect of the postoperative mean or variability of glucose, 17,24,36 ACEi, = angiotensin converting enzyme inhibitor; ARB = angiotensin II receptor blockers; BMI = body mass index; CABG = coronary artery bypass graft; CCB = calcium channel blocker; CI = confidence interval; COPD = chronic obstructive pulmonary disease; CPB = cardiopulmonary bypass; CV = coefficient of variation; GFR = glomerular filtration rate; HES = hydroxyethyl starch; LV = left ventricle; MBP = mean blood pressure; OR = odds ratio; PRBC = packed red blood cells; SCr = serum creatinine; TWAG = time-weighted average glucose adjustment for postoperative glucose control is warranted. Fifth, we did not use the urine output criteria for AKI diagnosis because accurate hourly urine output data were not available.…”