Perioperative glucose control.
OBJECTIVE
Hyperglycemia occurs commonly among acutely ill patients owing to a combination of counterregulatory and stress responses, as well as insulin resistance and deficiency, and is associated with increased morbidity and mortality in a variety of different patient populations. This manuscript reviews the adverse consequences of hyperglycemia in these different settings and focuses on perioperative glycemic management.


RESULTS
Hyperglycemia has a number of effects on the native immune system that may explain its role in increasing the risk of infection. Insulin may exert its beneficial effects by altering lipid metabolism as well as by modulating endothelial function through several mechanisms. Hyperglycemia during cardiac surgery is associated with increased risk of postoperative complications, including death. Several interventional studies have concluded that intensive glycemic management is beneficial, but there are limited data available from general surgical populations.


CONCLUSIONS
Hyperglycemia is associated with adverse outcomes in acutely ill adult patients and its treatment has been shown to improve mortality and morbidity in a variety of different settings. Additional studies are needed in heterogeneous populations of critically ill patients as well as in other populations of acutely ill patients, especially general surgical patients, to confirm the early studies and define the correct glycemic target.
Krinsley
James
J
Department of Critical Care, Stamford Hospital, Department of Medicine, Columbia University College of Physicians and Surgeons, Stamford, Connecticut 06902, USA. jkrinsley@stamhealth.org
D001786:Blood Glucose / Q000378:metabolism*; D002985:Clinical Protocols; D002986:Clinical Trials as Topic; D006801:Humans; D006943:Hyperglycemia / Q000150:complications / Q000628:therapy*; D019990:Perioperative Care
D001786:Blood Glucose