The impact of a reduced dose of dexamethasone on glucose control after coronary artery bypass surgery
<p>Abstract</p> <p>Background</p> <p>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....
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2007-12-01
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| Series: | Cardiovascular Diabetology |
| Online Access: | http://www.cardiab.com/content/6/1/39 |
| _version_ | 1811275991607148544 |
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| author | Boonstra Piet W van der Horst Iwan CC Janse Marcel Drost José T Hoekstra Miriam Vogelzang Mathijs Zijlstra Felix Loef Bert G Nijsten Maarten WN |
| author_facet | Boonstra Piet W van der Horst Iwan CC Janse Marcel Drost José T Hoekstra Miriam Vogelzang Mathijs Zijlstra Felix Loef Bert G Nijsten Maarten WN |
| author_sort | Boonstra Piet W |
| collection | DOAJ |
| description | <p>Abstract</p> <p>Background</p> <p>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.</p> <p>Methods</p> <p>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.</p> <p>Results</p> <p>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.</p> <p>Conclusion</p> <p>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.</p> |
| first_indexed | 2024-04-12T23:48:28Z |
| format | Article |
| id | doaj.art-c9dd70a2ab8b49208187eafdddcd8c4b |
| institution | Directory Open Access Journal |
| issn | 1475-2840 |
| language | English |
| last_indexed | 2024-04-12T23:48:28Z |
| publishDate | 2007-12-01 |
| publisher | BMC |
| record_format | Article |
| series | Cardiovascular Diabetology |
| spelling | doaj.art-c9dd70a2ab8b49208187eafdddcd8c4b2022-12-22T03:11:48ZengBMCCardiovascular Diabetology1475-28402007-12-01613910.1186/1475-2840-6-39The impact of a reduced dose of dexamethasone on glucose control after coronary artery bypass surgeryBoonstra Piet Wvan der Horst Iwan CCJanse MarcelDrost José THoekstra MiriamVogelzang MathijsZijlstra FelixLoef Bert GNijsten Maarten WN<p>Abstract</p> <p>Background</p> <p>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.</p> <p>Methods</p> <p>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.</p> <p>Results</p> <p>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.</p> <p>Conclusion</p> <p>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.</p>http://www.cardiab.com/content/6/1/39 |
| spellingShingle | Boonstra Piet W van der Horst Iwan CC Janse Marcel Drost José T Hoekstra Miriam Vogelzang Mathijs Zijlstra Felix Loef Bert G Nijsten Maarten WN The impact of a reduced dose of dexamethasone on glucose control after coronary artery bypass surgery Cardiovascular Diabetology |
| 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 |
| url | http://www.cardiab.com/content/6/1/39 |
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