1
|
Jucá FG, de Freitas FL, Goncharov M, Pes DDL, Jucá MEC, Dallan LRP, Lisboa LAF, Jatene FB, Mejia OAV. Difference Between Cardiopulmonary Bypass Time and Aortic Cross-Clamping Time as a Predictor of Complications After Coronary Artery Bypass Grafting. Braz J Cardiovasc Surg 2024; 39:e20230104. [PMID: 38426431 PMCID: PMC10903005 DOI: 10.21470/1678-9741-2023-0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/19/2023] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION Along with cardiopulmonary bypass time, aortic cross-clamping time is directly related to the risk of complications after heart surgery. The influence of the time difference between cardiopulmonary bypass and cross-clamping times (TDC-C) remains poorly understood. OBJECTIVE To assess the impact of cardiopulmonary bypass time in relation to cross-clamping time on immediate results after coronary artery bypass grafting in the Registro Paulista de Cirurgia Cardiovascular (REPLICCAR) II. METHODS Analysis of 3,090 patients included in REPLICCAR II database was performed. The Society of Thoracic Surgeons outcomes were evaluated (mortality, kidney failure, deep wound infection, reoperation, cerebrovascular accident, and prolonged ventilation time). A cutoff point was adopted, from which the increase of this difference would affect each outcome. RESULTS After a cutoff point determination, all patients were divided into Group 1 (cardiopulmonary bypass time < 140 min., TDC-C < 30 min.), Group 2 (cardiopulmonary bypass time < 140 min., TDC-C > 30 min.), Group 3 (cardiopulmonary bypass time > 140 min., TDC-C < 30 min.), and Group 4 (cardiopulmonary bypass time > 140 min., TDC-C > 30 min.). After univariate logistic regression, Group 2 showed significant association with reoperation (odds ratio: 1.64, 95% confidence interval: 1.01-2.66), stroke (odds ratio: 3.85, 95% confidence interval: 1.99-7.63), kidney failure (odds ratio: 1.90, 95% confidence interval: 1.32-2.74), and in-hospital mortality (odds ratio: 2.17, 95% confidence interval: 1.30-3.60). CONCLUSION TDC-C serves as a predictive factor for complications following coronary artery bypass grafting. We strongly recommend that future studies incorporate this metric to improve the prediction of complications.
Collapse
Affiliation(s)
- Fabiano Gonçalves Jucá
- Department of Cardiovascular Surgery, Hospital de Messejana Dr.
Carlos Alberto Studart Gomes, Fortaleza, Ceará, Brazil
- Department of Cardiovascular Surgery, Instituto do
Coração, Hospital das Clínicas, Faculdade de Medicina,
Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Fabiane Letícia de Freitas
- Department of Cardiovascular Surgery, Instituto do
Coração, Hospital das Clínicas, Faculdade de Medicina,
Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Maxim Goncharov
- Instituto de Pesquisa Hcor, Hospital do Coração,
São Paulo, São Paulo, Brazil
| | - Daniella de Lima Pes
- Department of Cardiovascular Surgery, Instituto do
Coração, Hospital das Clínicas, Faculdade de Medicina,
Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | | | - Luis Roberto Palma Dallan
- Department of Cardiovascular Surgery, Instituto do
Coração, Hospital das Clínicas, Faculdade de Medicina,
Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Luiz Augusto Ferreira Lisboa
- Department of Cardiovascular Surgery, Instituto do
Coração, Hospital das Clínicas, Faculdade de Medicina,
Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Fábio B. Jatene
- Department of Cardiovascular Surgery, Instituto do
Coração, Hospital das Clínicas, Faculdade de Medicina,
Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Omar Asdrúbal Vilca Mejia
- Department of Cardiovascular Surgery, Instituto do
Coração, Hospital das Clínicas, Faculdade de Medicina,
Universidade de São Paulo, São Paulo, São Paulo, Brazil
| |
Collapse
|
2
|
Vidlund M, Tajik B, Håkanson E, Friberg Ö, Holm J, Vanky F, Svedjeholm R. Post hoc analysis of the glutamics-trial: intravenous glutamate infusion and use of inotropic drugs after cabg. BMC Anesthesiol 2016; 16:54. [PMID: 27484576 PMCID: PMC4971701 DOI: 10.1186/s12871-016-0216-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 07/21/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intravenous glutamate reduced the risk of developing severe circulatory failure after isolated coronary artery bypass graft surgery (CABG) for acute coronary syndrome (ACS) in a double-blind randomised clinical trial (GLUTAMICS-ClinicalTrials.gov Identifier: NCT00489827 ). Here our aim was to study if glutamate was associated with reduced the use of inotropes. METHODS Post-hoc analysis of 824 patients undergoing isolated CABG for ACS in the GLUTAMICS-trial. ICU-records were retrospectively scrutinised including hourly registration of inotropic drug infusion, dosage and total duration during the operation and postoperatively. RESULTS ICU-records were found for 171 out of 177 patients who received inotropes perioperatively. Only one fourth of the patients treated with inotropes fulfilled study criteria for postoperative heart failure at weaning from cardiopulmonary bypass (CPB) or later in the ICU. Inotropes were mainly given preemptively to facilitate weaning from CPB or to treat postoperative circulatory instability (bleeding, hypovolaemia). Except for a significantly lower use of epinephrine there were only trends towards lower need of other inotropes overall in the glutamate group. In patients treated with inotropes (glutamate n = 17; placebo n = 13) who fulfilled study criteria for left ventricular failure at weaning from CPB the average duration of inotropic treatment (34 ± 20 v 80 ± 77 h; p = 0.014) and the number of inotropes used (1.35 ± 0.6 v 1.85 ± 0.7; p = 0.047) were lower in the glutamate group. CONCLUSIONS Intravenous glutamate was associated with a minor influence on inotrope use overall in patients undergoing CABG for ACS whereas a considerable and significant reduction was observed in patients with heart failure at weaning from CPB.
Collapse
Affiliation(s)
- Mårten Vidlund
- Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Bashir Tajik
- Department of Cardiothoracic Surgery and Cardiothoracic Anaesthesia, Faculty of Medicine and Health Sciences, Division of Cardiovascular Medicine, Linköping University, Linköping, Sweden
| | - Erik Håkanson
- Department of Cardiothoracic Surgery and Cardiothoracic Anaesthesia, Faculty of Medicine and Health Sciences, Division of Cardiovascular Medicine, Linköping University, Linköping, Sweden
| | - Örjan Friberg
- Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Jonas Holm
- Department of Cardiothoracic Surgery and Cardiothoracic Anaesthesia, Faculty of Medicine and Health Sciences, Division of Cardiovascular Medicine, Linköping University, Linköping, Sweden
| | - Farkas Vanky
- Department of Cardiothoracic Surgery and Cardiothoracic Anaesthesia, Faculty of Medicine and Health Sciences, Division of Cardiovascular Medicine, Linköping University, Linköping, Sweden
| | - Rolf Svedjeholm
- Department of Cardiothoracic Surgery and Cardiothoracic Anaesthesia, Faculty of Medicine and Health Sciences, Division of Cardiovascular Medicine, Linköping University, Linköping, Sweden.
| |
Collapse
|
3
|
Vidlund M, Håkanson E, Friberg Ö, Juhl-Andersen S, Holm J, Vanky F, Sunnermalm L, Borg JO, Sharma R, Svedjeholm R. GLUTAMICS—a randomized clinical trial on glutamate infusion in 861 patients undergoing surgery for acute coronary syndrome. J Thorac Cardiovasc Surg 2012; 144:922-930.e7. [DOI: 10.1016/j.jtcvs.2012.05.066] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Revised: 04/13/2012] [Accepted: 05/17/2012] [Indexed: 11/30/2022]
|
4
|
|
5
|
Svedjeholm R, Vidlund M, Vanhanen I, Håkanson E. A metabolic protective strategy could improve long-term survival in patients with LV-dysfunction undergoing CABG. SCAND CARDIOVASC J 2010; 44:45-58. [DOI: 10.3109/14017430903531008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
6
|
Vidlund M, Holm J, Håkanson E, Friberg O, Sunnermalm L, Vanky F, Svedjeholm R. The S-100B substudy of the GLUTAMICS trial: glutamate infusion not associated with sustained elevation of plasma S-100B after coronary surgery. Clin Nutr 2009; 29:358-64. [PMID: 19853332 DOI: 10.1016/j.clnu.2009.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 09/21/2009] [Accepted: 09/24/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND & AIMS Concerns have been raised about potential neurological injury related to exogenous glutamate. In cardiac surgery glutamate has been administered as a putative cardioprotective agent by cardioplegia or intravenous infusion. In the GLUTAMICS trial, in addition to surveillance of clinical neurological injuries, a prespecified subgroup was analyzed with regard to postoperative S-100B levels to detect potential subclinical neurological injury related to glutamate infusion. METHODS Sixty-nine patients operated on for unstable coronary syndrome were randomized to intravenous infusion of glutamate (n=35) or saline (n=34) perioperatively. Plasma levels of S-100B were obtained on the third postoperative day. RESULTS S-100B in the glutamate group and the control group were 0.079+/-0.034microg/L and 0.090+/-0.042microg/L respectively (p=0.245). There were no patients with stroke or mortality. Three patients in the control group and two in the glutamate group had postoperative confusion. These patients had significantly elevated S-100B compared with those without confusion (0.132+/-0.047vs 0.081+/-0.036microg/L; p=0.003). Overall, 21 patients had S-100B above reference level (> or =0.10microg/L) and these patients had significantly more calcifications in the ascending aorta on epiaortic scanning. CONCLUSIONS Intravenous glutamate infusion during surgery for unstable coronary artery disease did not initiate a sustained elevation of plasma S-100B. Thus, no evidence for subclinical neurological injury related to glutamate infusion was found. In contrast, postoperative elevation of plasma S-100B was linked to calcification of the ascending aorta and postoperative confusion.
Collapse
Affiliation(s)
- Mårten Vidlund
- Department of Cardiothoracic Surgery and Anesthesia, University Hospital Orebro, Sweden
| | | | | | | | | | | | | |
Collapse
|
7
|
Chang YL, Tsai YF, Lin PJ, Chen MC, Liu CY. Prevalence and Risk Factors for Postoperative Delirium in a Cardiovascular Intensive Care Unit. Am J Crit Care 2008. [DOI: 10.4037/ajcc2008.17.6.567] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Background Delirium after cardiac surgery is a common complication in cardiovascular intensive care units. The prevalence of delirium and its likely risk factors have not previously been explored in a single sample of postoperative cardiac patients in an intensive care unit.
Objective To compare a variety of characteristics in patients with and without delirium and to identify risk factors associated with delirium in patients hospitalized in an intensive care unit after cardiac surgery.
Methods A retrospective chart review was used to collect data on 288 patients who had open heart surgery during the period 2004 to 2005 at Chang Gung Memorial Hospital in northern Taiwan. A researcher-designed checklist of 52 patient-related risk factors for delirium was used to collect preoperative, intra-operative, and postoperative data. All patients were assessed by psychiatrists, and delirium was diagnosed according to criteria of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition. Data were analyzed via univariate analysis and multivariate logistic regression.
Results The prevalence of postoperative delirium was 41.7%. Patients with and without delirium differed significantly on 29 variables. Four postoperative factors, hematocrit less than 30%, cardiogenic shock, hypoalbuminemia, and acute infection, were significant, independent predictors of postoperative delirium.
Conclusions The results of this study can be used to develop a revised checklist of 29 preoperative, intraoperative, and postoperative risk factors for delirium, with special attention to the 4 predictive postoperative factors. Use of such a checklist may facilitate the ability to prevent or detect delirium early and provide suitable treatment.
Collapse
Affiliation(s)
- Yu-Ling Chang
- Yu-Ling Chang is a nurse practitioner in the Department of Cardiac Surgery, Pyng-Jing Lin is a professor in the Department of Cardiac Surgery, and Chia-Yih Liu is an associate professor, Department of Psychiatry, at Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
| | - Yun-Fang Tsai
- Yun-Fang Tsai is a professor in the School of Nursing, Chang Gung University, Tao-Yuan, Taiwan, and associate director, Department of Nursing, Chang Gung Memorial Hospital, Kee-Long, Taiwan
| | - Pyng-Jing Lin
- Yu-Ling Chang is a nurse practitioner in the Department of Cardiac Surgery, Pyng-Jing Lin is a professor in the Department of Cardiac Surgery, and Chia-Yih Liu is an associate professor, Department of Psychiatry, at Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
| | - Min-Chi Chen
- Min-Chi Chen is an associate professor, School of Medicine, Chang Gung University
| | - Chia-Yih Liu
- Yu-Ling Chang is a nurse practitioner in the Department of Cardiac Surgery, Pyng-Jing Lin is a professor in the Department of Cardiac Surgery, and Chia-Yih Liu is an associate professor, Department of Psychiatry, at Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
| |
Collapse
|
8
|
Brown JR, Edwards FH, O'Connor GT, Ross CS, Furnary AP. The diabetic disadvantage: historical outcomes measures in diabetic patients undergoing cardiac surgery -- the pre-intravenous insulin era. Semin Thorac Cardiovasc Surg 2007; 18:281-8. [PMID: 17395023 DOI: 10.1053/j.semtcvs.2006.04.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2006] [Indexed: 01/04/2023]
Abstract
Seven percent of the United States population is diabetic. However, diabetics are two to five times more likely to develop cardiovascular disease and therefore populate 30% of open heart procedures in this country. In addition, it has been well documented that diabetic cardiac surgery patients are further disadvantaged with worse outcomes following those procedures. This has been termed the "Diabetic Disadvantage." To benchmark these specific disadvantages, we evaluated the short- and long-term outcomes for diabetics and nondiabetics undergoing coronary artery bypass graft (CABG), CABG/valve, and aortic or mitral valve replacement surgery before the broader acceptance and use of intravenous insulin infusions in this patient population in 2001. All such patient records (n = 1,369,961) from the Society of Thoracic Surgeons national database operated on between 1990 and 2000 were assessed for short-term outcomes. Ten-year survival was evaluated among 36,835 patients from the Northern New England Cardiovascular Disease Study Group longitudinal registry. The diabetic population was found to have higher rates of 30-day mortality, deep sternal wound infection, stroke, and longer length of stay than the nondiabetic population. In addition, diabetic patients had approximately two-fold worse 10-year survival. All differences were statistically significant (P < 0.001). In summary, The Diabetic Disadvantage in the pre-intravenous insulin era is characterized by worse short- and long-term outcomes for diabetic patients undergoing cardiac surgery in the United States and Canada.
Collapse
Affiliation(s)
- Jeremiah R Brown
- Center for the Evaluative Clinical Sciences, Dartmouth Medical School, Lebanon, NH, USA.
| | | | | | | | | |
Collapse
|
9
|
Rubio-Regidor M, Pérez-Vela JL, Escribá-Bárcena A, Corres-Peiretti MA, Renes-Carreño E, Gutiérrez-Rodríguez J, Arribas-López P, Perales-Rodríguez de Viguri N. [Neurological complications in cardiac surgery post-operative period]. Med Intensiva 2007; 31:241-50. [PMID: 17580015 DOI: 10.1016/s0210-5691(07)74817-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The incidence of neurological complications after cardiac surgery continues to be elevated, although this is variable in the different studies published, fundamentally because of the different populations studied and the different definitions of neurological dysfunction. The etiology of these alterations is attributed to a multifactorial origin, aortic artherosclerosis, cerebral hypoperfusion and inflammatory phenomenon secondary to the technique. This review arises from the recognition of the personal, economic, and socio-health care repercussion entailed by these complications, with high rates of mortality and morbidity recorded, and it tries to give an objective view of the current literature on the subject. Having knowledge of the risk markers and understanding the pathogenesis is important to try to plan strategies that may minimize the appearance and development of these complications and contribute to the decrease of their serious consequences. The data and the experience obtained by our group are shown at the end of the review.
Collapse
Affiliation(s)
- M Rubio-Regidor
- Unidad de Postoperatorio de Cirugía Cardíaca, Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid.
| | | | | | | | | | | | | | | |
Collapse
|
10
|
Andréll P, Jensen C, Norrsell H, Ekre O, Ekholm S, Norrsell U, Eliasson T, Mannheimer C, Blomstrand C. White matter disease in magnetic resonance imaging predicts cerebral complications after coronary artery bypass grafting. Ann Thorac Surg 2005; 79:74-9; discussion 79-80. [PMID: 15620918 DOI: 10.1016/j.athoracsur.2004.06.085] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/25/2004] [Indexed: 11/17/2022]
Abstract
BACKGROUND The aim of the present study was to assess neurologic and neuropsychologic complications in 104 patients randomized to coronary artery bypass grafting or spinal cord stimulation. An additional objective of the study was to assess whether preoperative white matter disease might predict cerebral complications, as previous studies have shown that there is a relationship between white matter disease and neuropsychologic decline after coronary artery bypass grafting. METHODS The patients were subjected to neurologic examination before and six months after intervention. The patients underwent a cerebral magnetic resonance imaging before intervention and the presence of white matter disease was related to development of cerebral complications. RESULTS More patients in the bypass group than in the spinal cord stimulation group developed focal cerebral ischemia (p < 0.05) and astheno-emotional disorder (p < 0.001). More patients with white matter disease undergoing bypass were affected by focal cerebral ischemia (p < 0.01) and astheno-emotional disorder (p < 0.001) after the intervention compared to patients with white matter disease undergoing spinal cord stimulation. In patients with no white matter disease there were no differences between the bypass group and spinal cord stimulation group with regard to cerebral complications. CONCLUSIONS Patients undergoing bypass had more neurologic and neuropsychologic complications than patients undergoing spinal cord stimulation. Furthermore, patients with white matter disease were affected by cerebral complications in a higher extent after bypass than after spinal cord stimulation. Thus, preoperative assessment of white matter disease before undergoing coronary artery bypass grafting might predict the patient's risk of developing cerebral injury.
Collapse
Affiliation(s)
- Paulin Andréll
- Multidisciplinary Pain Center, Sahlgrenska University Hospital/Ostra, Göteborg, Sweden.
| | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Ridderstolpe L, Gill H, Borga M, Rutberg H, Ahlfeldt H. Canonical correlation analysis of risk factors and clinical outcomes in cardiac surgery. J Med Syst 2005; 29:357-77. [PMID: 16178334 DOI: 10.1007/s10916-005-5895-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Assessment of the association between risk factors and outcomes in cardiac surgery is a complex problem. The aim of this study was to explore the relationship between possible risk factors and several clinical outcomes in cardiac surgery by using canonical correlation analysis (CCA). This retrospective study of 2605 consecutive adult patients who underwent cardiac surgery, evaluated 74 potential risk factors and up to 12 outcomes by canonical correlation analysis. For three serious outcomes, sternal wound complications/mediastinitis, cerebral complications, and perioperative myocardial infarctions, CCA was preceded by univariate analyses and backward stepwise multivariate logistic regression analyses. The CCA suggests that the major risk factors for complications in these models are intraoperative and postoperative risk factors. The power of risk prediction models developed with multivariate regression analysis can be enhanced by application of canonical correlation analysis, thereby offering new ways of analyzing and interpreting sets of potential risk factors in relation to sets of clinical outcomes.
Collapse
Affiliation(s)
- Lisa Ridderstolpe
- Department of Biomedical Engineering/Medical Informatics, Linköping University, S-581 85 Linköping, Sweden
| | | | | | | | | |
Collapse
|
12
|
Szabó Z, Håkanson E, Maros T, Svedjeholm R. High-dose glucose-insulin-potassium after cardiac surgery: a retrospective analysis of clinical safety issues. Acta Anaesthesiol Scand 2003; 47:383-90. [PMID: 12694134 DOI: 10.1034/j.1399-6576.2003.00082.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Metabolic treatment with insulin or glucose-insulin-potassium (GIK) has received attention in association with myocardial infarction, cardiac surgery and critical care. As a result of insulin resistance during neuroendocrine stress, doses of insulin up to 1 IU kg-1 b.w.*h are required to achieve maximal metabolic effects after cardiac surgery. The clinical experience with regard to safety issues of such a high-dose GIK regime in critically ill patients after cardiac surgery is reported. METHODS Retrospective, observational study involving all patients treated with high-dose GIK after cardiac surgery during one year in a cardiovascular center at a University Hospital. RESULTS Eighty-nine patients out of 854 adult patients undergoing cardiac surgery were treated with high-dose GIK. Mean age was 69 +/- 1 years, Higgins score 5.3 +/- 0.3. Preoperatively 31.4% had left ventricular function EF< or =0.35 and 32.5% had sustained a myocardial infarct during surgery. Mortality was 5.6% and the average ICU stay was 3.7 +/- 0.5 days. The main indication for GIK was intraoperative heart failure (69.7%). The average glucose infusion rate during the first 6 h was 4.22 +/- 0.15 and 4.91 +/- 0.14 mg kg-1 b.w.*min, respectively, in diabetic and non-diabetic patients (P = 0.023). Blood glucose and s-potassium control was acceptable. CONCLUSIONS The high-dose GIK regime allowed substantial amounts of glucose to be infused both in diabetic and critically ill patients with maintenance of acceptable blood glucose control. Provided careful monitoring, this regime can be safely used in clinical practice and deserves further evaluation for treatment of critically ill patients following cardiac surgery.
Collapse
Affiliation(s)
- Z Szabó
- Departments of Cardiothoracic Anesthesia and Intensive Care and Cardiothoracic Surgery, Linköping Heart Center, University Hospital, Linköping, Sweden.
| | | | | | | |
Collapse
|
13
|
Chen Q, Ma E, Behar KL, Xu T, Haddad GG. Role of trehalose phosphate synthase in anoxia tolerance and development in Drosophila melanogaster. J Biol Chem 2002; 277:3274-9. [PMID: 11719513 DOI: 10.1074/jbc.m109479200] [Citation(s) in RCA: 122] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Recent studies have shown that trehalose plays a protective role in yeast in a variety of stresses, including heat, freezing and thawing, dehydration, hyperosmotic shock, and oxidant injury. Because (a) heat shock and anoxia share mechanisms that allow organisms to survive, (b) Drosophila melanogaster is tolerant to anoxia, and (c) trehalose is present in flies and is metabolically active, we asked whether trehalose can protect against anoxic stress. Here we report on a new role of trehalose in anoxia resistance in Drosophila. We first cloned the gene trehalose-6-phosphate synthase (tps1), which synthesizes trehalose, and examined the effect of tps1 overexpression as well as mutation on the resistance of Drosophila to anoxia. Upon induction of tps1, trehalose increased, and this was associated with increased tolerance to anoxia. Furthermore, in vitro experiments showed that trehalose reduced protein aggregation caused by anoxia. Homozygous tps1 mutant (P-element insertion into the third intron of the gene) leads to lethality at an early larval stage, and excision of the P-element rescues totally the phenotype. We conclude that trehalose contributes to anoxia tolerance in flies; this protection is likely to be due to a reduction of protein aggregation.
Collapse
Affiliation(s)
- Qiaofang Chen
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut 06520, USA
| | | | | | | | | |
Collapse
|