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2008, Number 4

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Rev Mex Anest 2008; 31 (4)

Strict control of glycemia and cardioprotection

Luna-Ortiz P, Carbó R, Rojas E, Micheli A, Pastelín G, Martínez M

Language: Spanish
References: 105
Page: 298-310
PDF size: 193.93 Kb.


ABSTRACT

Glucose homeostasis is seriously altered during stress periods such as sepsis, trauma and surgery. Blood glucose levels rise up in critically ill patients or during the perioperative period, without distinction between normal or diabetic patients. This condition has been called stress hyperglycemia, and for many years it has been considered an adaptive and beneficial response from the organism. However, new evidences have emerged showing that this condition increases morbidity and mortality in patients undergoing cardiac surgery and specially in those patients with extracorporeal circulation. In this review, it was analyzed the results of different studies of association between stress hyperglycemia and adverse outcomes of critically ill patients, those patients exposed to extensive surgery, especially cardiac surgery, as well as trauma patients. Here, the benefits of strict glycemic control (glucose levels between 80-110 mg/dL), using intensive insulin therapy in this group of patients are described. Additionally, the probable mechanisms of deleterious effects of the acute or chronical hyperglycemia and the most used protocols in the glycemic management are described. It is commented the experience obtained at the Instituto Nacional de Cardiología «Ignacio Chávez» in the management of patients at the surgery peri- and post-operative periods.


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