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J Thorac Cardiovasc Surg 2006;131:11-13
© 2006 The American Association for Thoracic Surgery

Editorial

Hyperglycemia during cardiac surgery

Department of Cardiothoracic Surgery, Boston Medical Center, Boston, Mass.

Received for publication May 13, 2005; accepted for publication May 26, 2005.

^_* Address for reprints: Harold L. Lazar, MD, Professor of Cardiothoracic Surgery/Attending Surgeon, Boston Medical Center, Cardiothoracic Surgery, 88 E. Newton St, Suite B 404, Boston MA 02118. (Email: harold.lazar@bmc.org).

The first 300 words of the full text of this article appear below.

In the 40 years since its introduction into clinical practice, the role of glucose-insulin-potassium (GIK) during cardiac surgery has remained undefined. ¹ Although there is growing evidence that hyperglycemia is detrimental and insulin therapy is beneficial to the diabetic patient during cardiac surgery, the significance of hyperglycemia in the nondiabetic cardiac surgical patient and the potential benefits of GIK are still the subject of intense debate.

In a recent issue of the Journal, Doenst and coworkers ² provide evidence that hyperglycemia is an independent predictor of perioperative morbidity and mortality in both diabetic and nondiabetic patients. Their study is unique in that they chose to assess the highest glucose level during cardiopulmonary bypass (CPB) as an independent variable rather than postoperative glucose levels. They hypothesized that this measurement would reflect perioperative insulin resistance and would not be influenced by inotropic agents. Their data corroborate our own work and that of others showing that diabetic patients with increased perioperative glucose levels (>200 mg/dL) have poorer outcomes after cardiac surgery. ^3-5 There is no controversy in these findings because all cardiac surgeons now agree that maintaining serum glucose levels at less than 200 mg/dL is the standard of practice for all diabetic patients in the perioperative period. The most optimal serum glucose level, length of treatment, contents of the insulin solution, and mechanisms responsible for these beneficial effects are now the subject of clinical investigations by our own group and other investigators.

Although there is no controversy regarding the detrimental effects of hyperglycemia and the benefits of insulin in the diabetic patient, the effects of hyperglycemia and the need for insulin therapy in the nondiabetic patient undergoing cardiac surgery are still the subject of debate. One of the shortcomings of the study by Doenst and coworkers ² is that the authors fail to distinguish between . . . [Full Text of this Article]

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