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The impact of a reduced dose of dexamethasone on glucose control after coronary artery bypass surgery

BACKGROUND: Intensive insulin therapy to maintain normoglycemia after cardiac surgery reduces morbidity and mortality. We investigated the magnitude and duration of hyperglycemia caused by dexamethasone administered after cardiopulmonary bypass. METHODS: A single-center before-after cohort study was...

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Autores principales: Vogelzang, Mathijs, Hoekstra, Miriam, Drost, José T, Janse, Marcel, van der Horst, Iwan CC, Boonstra, Piet W, Zijlstra, Felix, Loef, Bert G, Nijsten, Maarten WN
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2007
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2235839/
https://www.ncbi.nlm.nih.gov/pubmed/18086312
http://dx.doi.org/10.1186/1475-2840-6-39
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author Vogelzang, Mathijs
Hoekstra, Miriam
Drost, José T
Janse, Marcel
van der Horst, Iwan CC
Boonstra, Piet W
Zijlstra, Felix
Loef, Bert G
Nijsten, Maarten WN
author_facet Vogelzang, Mathijs
Hoekstra, Miriam
Drost, José T
Janse, Marcel
van der Horst, Iwan CC
Boonstra, Piet W
Zijlstra, Felix
Loef, Bert G
Nijsten, Maarten WN
author_sort Vogelzang, Mathijs
collection PubMed
description BACKGROUND: Intensive insulin therapy to maintain normoglycemia after cardiac surgery reduces morbidity and mortality. We investigated the magnitude and duration of hyperglycemia caused by dexamethasone administered after cardiopulmonary bypass. METHODS: A single-center before-after cohort study was performed. All consecutive patients undergoing coronary artery bypass grafting with cardiopulmonary bypass during a 6-month period were included. Insulin administration was guided by a sliding scale protocol. Halfway the observation period, the dexamethasone protocol was changed. The single dose (1D) group received a pre-operative dose of dexamethasone of 1 mg/kg. The double dose group (2D) received an additional dose of 0.5 mg/kg of dexamethasone post-operatively at ICU admission. RESULTS: We included 116 patients in the 1D group and 158 patients in the 2D group. There were no significant baseline differences between the groups. Median Euroscore was 5. In univariable analysis, the glucose level was different between groups 1D and 2D at 4, 6, 9, 12 and 24 hours after ICU admission (all p < 0.001). Insulin infusion was higher in the 1D group. Corrected for insulin dose in multivariable linear analysis, the difference in glucose between the 1D and 2D groups was 1.5 mmol/L (95% confidence interval 1.0–2.0, p < 0.001) 12 hours after ICU admission. CONCLUSION: Dexamethasone exerts a hyperglycemic effect in cardiac surgery patients. Patients receiving high-dose corticosteroid therapy should be monitored and treated more intensively for hyperglycemic episodes.
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spelling pubmed-22358392008-02-09 The impact of a reduced dose of dexamethasone on glucose control after coronary artery bypass surgery Vogelzang, Mathijs Hoekstra, Miriam Drost, José T Janse, Marcel van der Horst, Iwan CC Boonstra, Piet W Zijlstra, Felix Loef, Bert G Nijsten, Maarten WN Cardiovasc Diabetol Original Investigation BACKGROUND: Intensive insulin therapy to maintain normoglycemia after cardiac surgery reduces morbidity and mortality. We investigated the magnitude and duration of hyperglycemia caused by dexamethasone administered after cardiopulmonary bypass. METHODS: A single-center before-after cohort study was performed. All consecutive patients undergoing coronary artery bypass grafting with cardiopulmonary bypass during a 6-month period were included. Insulin administration was guided by a sliding scale protocol. Halfway the observation period, the dexamethasone protocol was changed. The single dose (1D) group received a pre-operative dose of dexamethasone of 1 mg/kg. The double dose group (2D) received an additional dose of 0.5 mg/kg of dexamethasone post-operatively at ICU admission. RESULTS: We included 116 patients in the 1D group and 158 patients in the 2D group. There were no significant baseline differences between the groups. Median Euroscore was 5. In univariable analysis, the glucose level was different between groups 1D and 2D at 4, 6, 9, 12 and 24 hours after ICU admission (all p < 0.001). Insulin infusion was higher in the 1D group. Corrected for insulin dose in multivariable linear analysis, the difference in glucose between the 1D and 2D groups was 1.5 mmol/L (95% confidence interval 1.0–2.0, p < 0.001) 12 hours after ICU admission. CONCLUSION: Dexamethasone exerts a hyperglycemic effect in cardiac surgery patients. Patients receiving high-dose corticosteroid therapy should be monitored and treated more intensively for hyperglycemic episodes. BioMed Central 2007-12-17 /pmc/articles/PMC2235839/ /pubmed/18086312 http://dx.doi.org/10.1186/1475-2840-6-39 Text en Copyright © 2007 Vogelzang et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( (http://creativecommons.org/licenses/by/2.0) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Investigation
Vogelzang, Mathijs
Hoekstra, Miriam
Drost, José T
Janse, Marcel
van der Horst, Iwan CC
Boonstra, Piet W
Zijlstra, Felix
Loef, Bert G
Nijsten, Maarten WN
The impact of a reduced dose of dexamethasone on glucose control after coronary artery bypass surgery
title The impact of a reduced dose of dexamethasone on glucose control after coronary artery bypass surgery
title_full The impact of a reduced dose of dexamethasone on glucose control after coronary artery bypass surgery
title_fullStr The impact of a reduced dose of dexamethasone on glucose control after coronary artery bypass surgery
title_full_unstemmed The impact of a reduced dose of dexamethasone on glucose control after coronary artery bypass surgery
title_short The impact of a reduced dose of dexamethasone on glucose control after coronary artery bypass surgery
title_sort impact of a reduced dose of dexamethasone on glucose control after coronary artery bypass surgery
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2235839/
https://www.ncbi.nlm.nih.gov/pubmed/18086312
http://dx.doi.org/10.1186/1475-2840-6-39
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