title: Glycemic control and outcome related to cardiopulmonary bypass.
abstract: Perioperative hyperglycemia, aggravated by cardiopulmonary bypass, is associated with adverse outcome in adult and pediatric patients. Whereas hyperglycemia was originally perceived as an adaptive response to surgical stress, it is now clear that glycemic control is a strategy to reduce adverse outcomes after cardiac surgery and cardiopulmonary bypass. The optimal blood glucose target, whether or not glycemic control should be initiated already intraoperatively, and whether or not perioperative glucose administration affects the impact of glycemic control on ischemia-reperfusion damage remain open questions. Hypoglycemia, the risk of which is increased with glycemic control, is also associated with adverse outcomes. However, it remains controversial whether brief episodes of hypoglycemia, rapidly corrected during glycemic control, have adverse effects on outcome. This review gives an overview of the currently available literature on glycemic control during and after cardiac surgery and focuses on the indicated open questions about this intervention for this specific patient population.
authors.affiliation: Clinical Division and Laboratory of Intensive Care Medicine, Department Cellular and Molecular Medicine, KU Leuven, B-3000 Leuven, Belgium.
authors.forename: Steven
authors.initials: S
authors.lastname: Thiessen
authors.affiliation: Clinical Division and Laboratory of Intensive Care Medicine, Department Cellular and Molecular Medicine, KU Leuven, B-3000 Leuven, Belgium.
authors.forename: Ilse
authors.initials: I
authors.lastname: Vanhorebeek
authors.affiliation: Clinical Division and Laboratory of Intensive Care Medicine, Department Cellular and Molecular Medicine, KU Leuven, B-3000 Leuven, Belgium. Electronic address: greet.vandenberghe@med.kuleuven.be.
authors.forename: Greet
authors.initials: G
authors.lastname: Van den Berghe
mesh_terms: D001786:Blood Glucose / Q000378:metabolism*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D038321:Glycemic Index / Q000502:physiology*; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000209:etiology / Q000517:prevention & control; D011183:Postoperative Complications / Q000097:blood* / Q000209:etiology / Q000517:prevention & control; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose
keywords: cardiac surgery; cardiopulmonary bypass; critical care; glucose variability; glycemic control; hyperglycemia; hypoglycemia; intensive insulin therapy