Association of increased morbidity with the occurrence of hyperglycemia in the immediate postoperative period after elective pediatric neurosurgery

OBJECTIVE The acute elevation of blood glucose in perioperative pediatric patients subjected to cardiac surgery and in victims of head trauma is associated with higher rates of postoperative complications. Data on the occurrence of hyperglycemia and its association with unfavorable outcomes among patients who have undergone elective neurosurgery are scarce in the literature. This study aimed to determine whether the occurrence of hyperglycemia during the perioperative period of elective neurosurgery for the resection of tumors of the CNS in children is associated with increased morbidity. METHODS This retrospective cohort analysis included 105 children up to 12 years of age who underwent elective neurosurgery for resection of supratentorial and infratentorial CNS tumors between January 2005 and December 2010 at the São Rafael Hospital, a tertiary care medical center in Salvador, Brazil. Demographic data and intraoperative and postoperative information were collected from the medical records. Differences in blood glucose levels during the perioperative period were evaluated with nonparametric tests. RESULTS The patients who developed postoperative complications exhibited higher blood glucose levels on admission to the intensive care unit (ICU) (162.0 ± 35.8 mg/dl vs 146.3 ± 43.3 mg/dl; p = 0.016) and peak blood glucose levels on postoperative Day 1 (171.9 ± 30.2 mg/dl vs 156.1 ± 43.2 mg/dl; p = 0.008). Multivariate analysis showed that peak blood glucose levels on postoperative Day 1 were independently associated with a higher odds ratio for postoperative complication (OR 1.05). The occurrence of hyperglycemia (>150 mg/dl) upon admission to the ICU was associated with longer ICU (p = 0.003) and hospital (p = 0.001) stays. CONCLUSIONS The occurrence of hyperglycemia during the postoperative period after elective pediatric neurosurgery for the resection of CNS tumors was associated with longer hospital and ICU stays. Postoperative complications were associated with higher blood glucose levels upon admission to the ICU and higher peak blood glucose on the first postoperative day.

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Association of Hyperglycaemia with Outcome in Critically Ill Children in Central India - A Prospective Study

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/159 ◽

2021 ◽

Vol 8 (13) ◽

pp. 811-815

Author(s):

Suman Sudha Tirkey ◽

Rakesh Kumar Verma

Keyword(s):

Intensive Care Unit ◽

Blood Glucose ◽

Critically Ill ◽

Central India ◽

Critically Ill Children ◽

Glucose Levels ◽

Blood Glucose Levels ◽

Mean Blood Glucose ◽

Peak Blood ◽

Peak Blood Glucose

BACKGROUND Hyperglycaemia is a common occurrence in children with critical illness. Several studies relate hyperglycaemia occurring during intensive care unit (ICU) admission to be associated with increased mortality. We wanted to evaluate the incidence of hyperglycaemia and its association with mortality among critically ill children. METHODS A prospective observational study was conducted among critically ill children admitted to the Paediatric Intensive Care Unit (PICU) of a tertiary care centre, Raipur, Chhattisgarh in central India, from 1st May 2016 to 31st October 2016. All patients aged 1 month to 14 years who were admitted in PICU during this study period (N = 113) were included. Children who were known cases of diabetes mellitus, hepatic failure or renal failure requiring dialysis and children who left against medical advice (LAMA) or died within 24 hours of admission were excluded (N = 13). Thus 100 children were included in the study. RESULTS In the study population, incidence of hyperglycaemia was 60 %; overall 37 (37 %) died and the mortality rate was significantly higher (46.6 % vs. 19.4 %) in children with hyperglycaemia than in children without hyperglycaemia. Nonsurvivors had higher mean blood glucose levels at 48 hours (218.35 ± 87.42 mg / dL) than survivors (141.12 ± 55.26 mg / dL) (P < .001). Peak blood glucose (218.35 ± 87.42 mg / dL vs. 141.12 ± 55.26 mg / dL), need for mechanical ventilation (54.5 % vs. 27.3 %), need for inotropes (76.4 % vs. 23.5 %) and Paediatric Risk of Mortality Score (PRISM) III (16.25 ± 5.46 vs. 9.06 ± 4.35) were significantly higher in non-survivors than in survivors. On regression analysis, blood sugar at 24 hours and duration of stay were found to be significant. CONCLUSIONS In this study, in the PICU, the mortality rate was significantly higher in children with hyperglycaemia than in children without hyperglycaemia. Non-survivors had significantly higher mean blood glucose levels at 48 hours than survivors. Peak blood glucose, need for mechanical ventilation, need for inotropes and PRISM III scores were significantly higher in non-survivors than in survivors. KEYWORDS Hyperglycaemia, Critically Ill, PICU, Outcome, Mortality

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Glycemic control is associated with lower odds of mortality and successful extubation in severe COVID-19

Journal of Osteopathic Medicine ◽

10.1515/jom-2021-0182 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Jay M. Pescatore ◽

Juan Sarmiento ◽

Ruben A. Hernandez-Acosta ◽

Britt Skaathun ◽

Nancy Quesada-Rodriguez ◽

...

Keyword(s):

Blood Glucose ◽

Patient Characteristics ◽

Lower Blood Glucose ◽

Lower Odds ◽

Glucose Levels ◽

Blood Glucose Levels ◽

Lower Blood ◽

Peak Blood ◽

Peak Blood Glucose ◽

Successful Extubation

Abstract Context Corticosteroids, specifically dexamethasone, have become the mainstay of treatment for moderate to severe COVID-19. Although the RECOVERY trial did not report adverse effects of corticosteroids, the METCOVID (Methylprednisolone as Adjunctive Therapy for Patients Hospitalized with COVID-19) study reported a higher blood glucose level in patients receiving methylprednisolone. Objectives This study aims to analyze the association between corticosteroids and COVID-19–related outcomes in patients admitted to the medical ICU (MICU) for COVID-19 pneumonia. Methods This is an observational study of 141 patients admitted to the MICU between March 18 and June 7, 2020. Data on demographics, laboratory and imaging studies, and clinical course were obtained, including data on corticosteroid use. Bivariate analyses and logistic regression were performed between patient characteristics and mortality and successful extubation. Results Of the 141 patients, 86 required mechanical ventilation, 50 received steroids, and 71 died. Regarding demographics, patients had a median age of 58 (interquartile range [IQR] 48, 65), Hispanic (57.4%, n=81), and non-Hispanic Black (37.5%, n=53). The most prevalent comorbidities were hypertension (49.6%, n=70) and diabetes (48.2%, n=68). Lower blood glucose levels on admission (125.5 vs. 148 mg/dL, p=0.025) and lower peak blood glucose levels on corticosteroids (215.5 vs. 361 mg/dL, p=0.0021) were associated with lower prevalence of mortality. Patients who were successfully extubated had a lower admission blood glucose (126.5 vs. 149 mg/dL, p=0.0074) and lower peak blood glucose on corticosteroids (217 vs. 361 mg/dL, p=0.0023). Conclusions Lower blood glucose on admission and lower maximum blood glucose on corticosteroids were associated with lower odds of mortality and successful extubation, regardless of preexisting diabetes. Hyperglycemia may be negating any potential benefit of corticosteroid therapy. These findings suggest that glucose control could be a parameter that impacts the outcome of patients receiving corticosteroids for COVID-19 pneumonia.

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Acute Metabolic Responses to Glucose and Fructose Supplementation in Healthy Individuals: A Double-Blind Randomized Crossover Placebo-Controlled Trial

Nutrients ◽

10.3390/nu13114095 ◽

2021 ◽

Vol 13 (11) ◽

pp. 4095

Author(s):

Max L. Eckstein ◽

Antonia Brockfeld ◽

Sandra Haupt ◽

Janis R. Schierbauer ◽

Rebecca T. Zimmer ◽

...

Keyword(s):

Blood Glucose ◽

Controlled Trial ◽

Healthy Individuals ◽

Double Blind ◽

Glucose Response ◽

Glucose Levels ◽

Blood Glucose Levels ◽

The Impact ◽

Peak Blood ◽

Peak Blood Glucose

The aim of this study was to investigate the impact of glucose (Glu), fructose (Fru), glucose and fructose (GluFru) and sucralose on blood glucose response in healthy individuals. Fifteen healthy individuals (five females, age of 25.4 ± 2.5 years, BMI of 23.7 ± 1.7 kg/m2 with a body mass (BM) of 76.3 ± 12.3 kg) participated in this double-blind randomized crossover placebo-controlled trial. Participants received a mixture of 300 mL of water with 1 g/kg BM of Glu, 1 g/kg BM of Fru, 0.5 g/kg BM of GluFru (each), and 0.2 g sucralose as a placebo. Peak BG values Glu were reached after 40 ± 13 min (peak BG: 141 ± 20 mg/dL), for Fru after 36 ± 22 min (peak BG: 98 ± 7 mg/dL), for GluFru after 29 ± 8 min (BG 128 ± 18 mg/dL), and sucralose after 34 ± 27 min (peak BG: 83 ± 5 mg/dL). Significant differences regarding the time until peak BG were found only between Glu and GluFru supplementation (p = 0.02). Peak blood glucose levels were significantly lower following the ingestion of Fru compared to the supplementation of Glu and GluFru (p < 0.0001) while Glu and GluFru supplementation showed no difference in peak values (p = 0.23). All conditions led to a significantly higher peak BG value compared to sucralose (p < 0.0001). Blood lactate increased in Glu (p = 0.002), Fru and GluFru (both p < 0.0001), whereas sucralose did not increase compared to the baseline (p = 0.051). Insulin levels were significantly higher in all conditions at peak compared to sucralose (p < 0.0001). The findings of this study prove the feasibility of combined carbohydrate supplementations for many applications in diabetic or healthy exercise cohorts.

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Carbohydrate balance in the perioperative period

Infusion & Chemotherapy ◽

10.32902/2663-0338-2020-3.2-28-30 ◽

2020 ◽

pp. 28-30

Author(s):

O.A. Halushko

Keyword(s):

Blood Glucose ◽

Ketone Bodies ◽

Perioperative Period ◽

Infectious Complications ◽

Preoperative Preparation ◽

Electrolyte Disorders ◽

Glucose Levels ◽

Blood Glucose Levels ◽

Adequate Hydration ◽

Life Threatening

Background. Deep and multifaceted disorders during the perioperative period can lead to severe metabolic disorders that are life-threatening and require immediate care. Such conditions include the disorders of carbohydrate metabolism (CHM). Objective. To describe CHM disorders in the perioperative period and the possibility of their correction. Materials and methods. Analysis of literature sources on this topic. Results and discussion. The pathogenesis of CHM disorders in the perioperative period includes such links as the impact of surgical stress and/or infections, relative insulin deficiency, increased production of ketone bodies etc. Grades of CHM disorders include compensation (normoglycemia, aglucosuria), subcompensation (moderate glycemia (up to 13.9 mmol/L), slight glucosuria), and decompensation (high glycemia, significant glucosuria, ketone bodies). The main tasks of preoperative preparation in patients with CHM disorders include CHM normalization, correction of volemic disorders, maximum compensation of renal function, prevention and treatment of infectious complications. Glycemic levels in perioperative CHM disorders are highly variable and are not always associated with the severity of the condition, although glycemia >30 mmol/L is usually associated with severe diabetic ketoacidosis. Surgery is one of the triggers of stress hyperglycemia (for patients without diabetes, the glucose level in these cases is 7.7-11.0 mmol/L). In the treatment of persistent hyperglycemia in hospitalized patients, insulin therapy should be initiated, starting from a blood glucose threshold of 10.0 mmol/L. The target is 7.8-10.0 mmol/L. Ketoacidotic coma is an absolute contraindication to surgery due to concomitant severe water-electrolyte disorders. Surgery for vital indications can be performed only after restorative measures in 3-4 hours after recovery of consciousness and reduction of glycemia to <15 mmol/L. Only profuse, life-threatening bleeding can be the basis for reducing the time and volume of preoperative preparation of a patient with diabetes decompensation. Criteria of readiness for surgery include normal or close to normal blood glucose levels, adequate hydration and elimination of ketoacidosis. In patients with severe diabetes, relative compensation (8.8-10.0 mmol/L) can be used as a criterion. Most researchers recommend transitioning patients with impaired CHM to simple insulin injections before surgery. Insulin concentration is important for wound healing and prevention of purulent complications. Sodium bicarbonate or Soda-Bufer (“Yuria-Pharm”) can be used to correct metabolic acidosis. Ketogenesis should be eliminated with xylitol (Xylate, “Yuria-Pharm”). Routine glucose use in critically ill patients has been abandoned. Conclusions. 1. Many patients in the perioperative period develop CHM disorders, which worsen the course of the underlying disease. 2. The main tasks of preoperative preparation in patients with CHM disorders are CHM normalization, correction of volemic disorders, maximum compensation of renal function, prevention and treatment of infectious complications. 3. In the treatment of persistent hyperglycemia in hospitalized patients, insulin therapy should be started, starting from the glycemic threshold of 10.0 mmol/L. 4. Ketoacidotic coma is an absolute contraindication to surgery due to concomitant severe water-electrolyte disorders. 5. Criteria of readiness for surgery include normal or close to normal blood glucose levels, adequate hydration and elimination of ketoacidosis. 6. Sodium bicarbonate or Soda-Bufer can be used to correct metabolic acidosis. 7. Ketogenesis should be eliminated with Xylate.

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