Volume 10 Supplement 1

de Senectute: Age and Health Forum

Open Access

Intensive versus conventional insulinotherapy after elective and on-pump myocardial revascularization in the elderly patient: a prospective and randomized study

  • S Caroleo1,
  • F Onorati2,
  • A Rubino2,
  • F Calandese1,
  • C De Munda1,
  • E Santangelo3,
  • A Renzulli2 and
  • B Amantea1
BMC Geriatrics201010(Suppl 1):A98

https://doi.org/10.1186/1471-2318-10-S1-A98

Published: 19 May 2010

Background

In cardiac surgery patients, hyperglycemia was found to be an independent post-operative risk factor for the development of hyperlactatemia and associated with increased morbidity and mortality [1].

Materials and methods

Design: analysis of a prospective and randomized collected database.

Patients: A total of 40 patients (23M; 17F) aged >65 (ASA II-III) submitted to elective on-pump myocardial revascularization from September 2007 to May 2009.

Randomization: on ICU admission, once obtained a preoperative informed consent, the patients were randomly assigned to Group 1 (intensive insulinotherapy during the first 24 hours of ICU stay aimed at glucose levels between 80-110 mg/dl) or Group 2 (conventional insulinotherapy during the first 24 hours of ICU stay aimed at glucose levels between 160-180 mg/dl).

Data collection: Preoperative and each hour (during the first 24 hours in ICU) assessment of Glucose and Lactate blood levels and Body Temperature; Hemodynamic parameters on ICU admission and after 2, 6, 12 and 24 hours. Preoperative and postoperative (12 and 36 hours after ICU admission) assessment of C-Reactive Protein (CRP), White Blood Cells (WBC) and Platelets (PLT) blood levels. Admission, Total Maximum (TMSOFA) and Δ SOFA score (5). Infection Probability Score (IPS) 36 hours after ICU admission.

Statistics: Within-between groups analysis, one-way ANOVA and unpaired t-Test were used when appropriate.

Results

No difference in preoperative and operative variables (p=NS for all measurements). Glucose and Lactate blood levels were lower in Group 1 (p <0.0001). Haemodynamic parameters were comparable between Groups except Indexed Vascular Resistances that were higher in Group 1 (p<0.05). CRP levels were lower in Group 1 (p<0.0001), PLT levels were higher in Group 1 (p<0.0001). Admission and TM SOFA score were lower in Group 1 (p<0.0001), IPS was lower in Group 1 (p<0.01).

Conclusions

Intensive insulinotherapy after elective and on-pump myocardial revascularization modulates the inflammatory pattern and can improve clinical response in this setting.

Authors’ Affiliations

(1)
Deparment of Anaesthesia and Reanimation, University of Catanzaro
(2)
Department of Cardiac Surgery, University of Catanzaro
(3)
Department of Anaesthesia and Oncological Intensive Care, University of Catanzaro

References

  1. Hoedemaekers CW, Pickkers P, Netea MG, van Deuren M, Van der Hoeven JG: Intensive insulin therapy does not alter the inflammatory response in patients undergoing coronary artery bypass grafting: a randomized controlled trial [ISRCTN95608630]. Crit Care. 2005, 9 (6): R790-7. 10.1186/cc3911.PubMedPubMed CentralView ArticleGoogle Scholar

Copyright

© Caroleo et al; licensee BioMed Central Ltd. 2010

This article is published under license to BioMed Central Ltd.

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