Coronary artery bypass surgery maintaining glucose level

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Saphenous Vein Graft Disease
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Anahita Deylamsalehi, M.D.[2] Varun Kumar, M.B.B.S. [3]

Overview

Maintaining Glucose Level in CABG

2022 ACA Revascularization Guideline

Class 1 Recommendation, Level of Evidence: B-R [1][2][3][4][5][6][7]
1. In order to reduce sternal wound infection in patients undergoing CABG an intraoperative continuous infusion of insulin should be initiated with the goal to keep blood sugar lower than 180 mg/dL.

2. In order to reduce sternal wound infection in patients undergoing CABG an postoperative continuous infusion of insulin is recommended with the goal to keep an early postoperative blood sugar lower than 180 mg/dL.

Class 1 Recommendation, Level of Evidence: B-NR [1][8][9][10][11][12][13]
A comprehensive approach to decrease the risk of sternal wound infection is recommended in patients undergoing CABG.
Class 2b Recommendation, Level of Evidence: B-R[1][5]
The effectiveness of intraoperative continuous infusion of insulin with the goal to keep blood sugar lower than 140 mg/dL in patients undergoing CABG is not certain.

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery (DO NOT EDIT)[14]

Class I
"1. Use of continuous intravenous insulin to achieve and maintain an early postoperative blood glucose concentration less than or equal to 180 mg/dL while avoiding hypoglycemia is indicated to reduce the incidence of adverse events, including deep sternal wound infection, after CABG.[6][15][16] (Level of Evidence: B)"
Class IIb
"1. The use of continuous intravenous insulin designed to achieve a target intraoperative blood glucose concentration less than 140 mg/dL has uncertain effectiveness.[17][18][19] (Level of Evidence: B)"


References

  1. ↑ 1.0 1.1 1.2 Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM; et al. (2022). "2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". J Am Coll Cardiol. 79 (2): e21–e129. doi:10.1016/j.jacc.2021.09.006. PMID 34895950 Check |pmid= value (help).
  2. ↑ Furnary AP, Zerr KJ, Grunkemeier GL, Starr A (1999). "Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures". Ann Thorac Surg. 67 (2): 352–60, discussion 360-2. doi:10.1016/s0003-4975(99)00014-4. PMID 10197653.
  3. ↑ Hruska LA, Smith JM, Hendy MP, Fritz VL, McAdams S (2005). "Continuous insulin infusion reduces infectious complications in diabetics following coronary surgery". J Card Surg. 20 (5): 403–7. doi:10.1111/j.1540-8191.2005.200472.x. PMID 16153268.
  4. ↑ Lazar HL, Chipkin SR, Fitzgerald CA, Bao Y, Cabral H, Apstein CS (2004). "Tight glycemic control in diabetic coronary artery bypass graft patients improves perioperative outcomes and decreases recurrent ischemic events". Circulation. 109 (12): 1497–502. doi:10.1161/01.CIR.0000121747.71054.79. PMID 15006999.
  5. ↑ 5.0 5.1 Umpierrez G, Cardona S, Pasquel F, Jacobs S, Peng L, Unigwe M; et al. (2015). "Randomized Controlled Trial of Intensive Versus Conservative Glucose Control in Patients Undergoing Coronary Artery Bypass Graft Surgery: GLUCO-CABG Trial". Diabetes Care. 38 (9): 1665–72. doi:10.2337/dc15-0303. PMC 4542267. PMID 26180108.
  6. ↑ 6.0 6.1 Furnary AP, Gao G, Grunkemeier GL, Wu Y, Zerr KJ, Bookin SO; et al. (2003). "Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting". J Thorac Cardiovasc Surg. 125 (5): 1007–21. doi:10.1067/mtc.2003.181. PMID 12771873.
  7. ↑ Furnary AP, Wu Y (2006). "Eliminating the diabetic disadvantage: the Portland Diabetic Project". Semin Thorac Cardiovasc Surg. 18 (4): 302–8. doi:10.1053/j.semtcvs.2006.04.005. PMID 17395026.
  8. ↑ Edwards LD (1976). "The epidemiology of 2056 remote site infections and 1966 surgical wound infections occurring in 1865 patients: a four year study of 40,923 operations at Rush-Presbyterian-St. Luke's Hospital, Chicago". Ann Surg. 184 (6): 758–66. doi:10.1097/00000658-197612000-00017. PMC 1345421. PMID 999352.
  9. ↑ Engelman R, Shahian D, Shemin R, Guy TS, Bratzler D, Edwards F; et al. (2007). "The Society of Thoracic Surgeons practice guideline series: Antibiotic prophylaxis in cardiac surgery, part II: Antibiotic choice". Ann Thorac Surg. 83 (4): 1569–76. doi:10.1016/j.athoracsur.2006.09.046. PMID 17383396.
  10. ↑ Lazar HL, Salm TV, Engelman R, Orgill D, Gordon S (2016). "Prevention and management of sternal wound infections". J Thorac Cardiovasc Surg. 152 (4): 962–72. doi:10.1016/j.jtcvs.2016.01.060. PMID 27555340.
  11. ↑ Vander Salm TJ, Okike ON, Pasque MK, Pezzella AT, Lew R, Traina V; et al. (1989). "Reduction of sternal infection by application of topical vancomycin". J Thorac Cardiovasc Surg. 98 (4): 618–22. PMID 2796369.
  12. ↑ Steingrímsson S, Gustafsson R, Gudbjartsson T, Mokhtari A, Ingemansson R, Sjögren J (2009). "Sternocutaneous fistulas after cardiac surgery: incidence and late outcome during a ten-year follow-up". Ann Thorac Surg. 88 (6): 1910–5. doi:10.1016/j.athoracsur.2009.07.012. PMID 19932261.
  13. ↑ Kieser TM, Rose MS, Aluthman U, Montgomery M, Louie T, Belenkie I (2014). "Toward zero: deep sternal wound infection after 1001 consecutive coronary artery bypass procedures using arterial grafts: implications for diabetic patients". J Thorac Cardiovasc Surg. 148 (5): 1887–95. doi:10.1016/j.jtcvs.2014.02.022. PMID 24613159.
  14. ↑ Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG; et al. (2011). "2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". Circulation. doi:10.1161/CIR.0b013e31823c074e. PMID 22064599.
  15. ↑ Ingels C, Debaveye Y, Milants I, Buelens E, Peeraer A, Devriendt Y, Vanhoutte T, Van Damme A, Schetz M, Wouters PJ, Van den Berghe G (2006). "Strict blood glucose control with insulin during intensive care after cardiac surgery: impact on 4-years survival, dependency on medical care, and quality-of-life". European Heart Journal. 27 (22): 2716–24. doi:10.1093/eurheartj/ehi855. PMID 16608860. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  16. ↑ van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P, Bouillon R (2001). "Intensive insulin therapy in the critically ill patients". The New England Journal of Medicine. 345 (19): 1359–67. doi:10.1056/NEJMoa011300. PMID 11794168. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  17. ↑ Butterworth J, Wagenknecht LE, Legault C, Zaccaro DJ, Kon ND, Hammon JW, Rogers AT, Troost BT, Stump DA, Furberg CD, Coker LH (2005). "Attempted control of hyperglycemia during cardiopulmonary bypass fails to improve neurologic or neurobehavioral outcomes in patients without diabetes mellitus undergoing coronary artery bypass grafting". The Journal of Thoracic and Cardiovascular Surgery. 130 (5): 1319. doi:10.1016/j.jtcvs.2005.02.049. PMID 16256784. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  18. ↑ Duncan AE, Abd-Elsayed A, Maheshwari A, Xu M, Soltesz E, Koch CG (2010). "Role of intraoperative and postoperative blood glucose concentrations in predicting outcomes after cardiac surgery". Anesthesiology. 112 (4): 860–71. doi:10.1097/ALN.0b013e3181d3d4b4. PMID 20216389. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  19. ↑ Gandhi GY, Nuttall GA, Abel MD, Mullany CJ, Schaff HV, O'Brien PC, Johnson MG, Williams AR, Cutshall SM, Mundy LM, Rizza RA, McMahon MM (2007). "Intensive intraoperative insulin therapy versus conventional glucose management during cardiac surgery: a randomized trial". Annals of Internal Medicine. 146 (4): 233–43. PMID 17310047. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)

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