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  • Blaha, Jan  (2)
  • Medicine  (2)
  • 1
    Online Resource
    Online Resource
    Blood Glucose Control by a Model Predictive Control Algorithm with Variable Sampling Rate Versus a Routine Glucose Management Protocol in Cardiac Surgery Patients: A Randomized Controlled Trial
    The Endocrine Society ; 2007
    In:  The Journal of Clinical Endocrinology & Metabolism Vol. 92, No. 8 ( 2007-08-01), p. 2960-2964
    Details
    In: The Journal of Clinical Endocrinology & Metabolism, The Endocrine Society, Vol. 92, No. 8 ( 2007-08-01), p. 2960-2964
    Abstract: Context: Elevated blood glucose levels occur frequently in the critically ill. Tight glucose control by intensive insulin treatment markedly improves clinical outcome. Objective and Design: This is a randomized controlled trial comparing blood glucose control by a laptop-based model predictive control algorithm with a variable sampling rate [enhanced model predictive control (eMPC); version 1.04.03] against a routine glucose management protocol (RMP) during the peri- and postoperative periods. Setting: The study was performed at the Department of Cardiac Surgery, University Hospital. Patients: A total of 60 elective cardiac surgery patients were included in the study. Interventions: Elective cardiac surgery and treatment with continuous insulin infusion (eMPC) or continuous insulin infusion combined with iv insulin boluses (RMP) to maintain euglycemia (target range 4.4–6.1 mmol/liter) were performed. There were 30 patients randomized for eMPC and 30 for RMP treatment. Blood glucose was measured in 1- to 4-h intervals as requested by each algorithm during surgery and postoperatively over 24 h. Main Outcome Measures: Mean blood glucose, percentage of time in target range, and hypoglycemia events were used. Results: Mean blood glucose was 6.2 ± 1.1 mmol/liter in the eMPC vs. 7.2 ± 1.1 mmol/liter in the RMP group (P & lt; 0.05); percentage of time in the target range was 60.4 ± 22.8% for the eMPC vs. 27.5 ± 16.2% for the RMP group (P & lt; 0.05). No severe hypoglycemia (blood glucose & lt; 2.9 mmol/liter) occurred during the study. Mean insulin infusion rate was 4.7 ± 3.3 IU/h in the eMPC vs. 2.6 ± 1.7 IU/h in the RMP group (P & lt; 0.05). Mean sampling interval was 1.5 ± 0.3 h in the eMPC vs. 2.1 ± 0.2 h in the RMP group (P & lt; 0.05). Conclusions: Compared with RMP, the eMPC algorithm was more effective and comparably safe in maintaining euglycemia in cardiac surgery patients.
    Type of Medium: Online Resource
    ISSN: 0021-972X , 1945-7197
    URL: Article
    DOI: 10.1210/jc.2007-0434
    RVK:
    XA 10000
    Language: English
    Publisher: The Endocrine Society
    Publication Date: 2007
    detail.hit.zdb_id: 2026217-6
    Location Call Number Limitation Availability
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    Online Resource
  • 2
    Online Resource
    Online Resource
    Increased Subcutaneous and Epicardial Adipose Tissue Production of Proinflammatory Cytokines in Cardiac Surgery Patients: Possible Role in Postoperative Insulin Resistance
    The Endocrine Society ; 2006
    In:  The Journal of Clinical Endocrinology & Metabolism Vol. 91, No. 11 ( 2006-11-01), p. 4620-4627
    Details
    In: The Journal of Clinical Endocrinology & Metabolism, The Endocrine Society, Vol. 91, No. 11 ( 2006-11-01), p. 4620-4627
    Abstract: Context: Hyperglycemia and insulin resistance frequently occur in critically ill patients even without a history of diabetes. Objective: Our objective was to study the role of adipose tissue hormonal production in the development of insulin resistance in cardiac surgery patients. Participants, Interventions, and Settings: Fifteen patients with elective cardiac surgery underwent blood sampling before, at the end, and 6, 12, 24, 48, and 120 h after the end of their operation. Epicardial and sc adipose tissue sampling was done at the beginning and at the end of surgery in the Department of Cardiac Surgery. Main Outcome Measures: We measured serum concentrations and sc and epicardial adipose tissue mRNA expression of IL-6, monocyte chemoattractant protein-1 (MCP-1), TNF-α, leptin, resistin, and adiponectin and sc and epicardial adipose tissue mRNA expression of CD14, CD45, and CD68. Results: The rate of insulin infusion required to maintain euglycemia increased up to 7-fold 12 h after the operation, suggesting the development of insulin resistance. Serum IL-6 levels increased 43-fold 12 h after surgery. MCP-1 peaked 6-fold at the end of surgery. Smaller peaks of TNF-α and leptin appeared 6 and 12 h after surgery, respectively. Resistin levels peaked 4-fold 24 h after surgery, but adiponectin levels were not significantly affected. TNF-α and CD45 mRNA expression increased markedly during the operation in sc adipose tissue. IL-6, resistin, and MCP-1 mRNA expression increased in both sc and epicardial adipose tissue. Leptin, adiponectin, CD14, and CD68 mRNA expression did not change significantly. Conclusions: Both sc and epicardial adipose tissue is a source of proinflammatory cytokines in cardiac surgery patients and may contribute to the development of postoperative insulin resistance.
    Type of Medium: Online Resource
    ISSN: 0021-972X , 1945-7197
    URL: Article
    DOI: 10.1210/jc.2006-1044
    RVK:
    XA 10000
    Language: English
    Publisher: The Endocrine Society
    Publication Date: 2006
    detail.hit.zdb_id: 2026217-6
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
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