Abstract
Purpose
Recent studies have reported that controlling blood glucose with insulin can suppress systemic inflammation. In the present study, we evaluated how perioperative intensive insulin therapy (IIT) influences the inflammatory response in an artificial pancreas during cardiac surgery with cardiopulmonary bypass.
Methods
We randomly divided the patients undergoing cardiac surgery with cardiopulmonary bypass into two groups: an IIT group (n = 13) and a conventional treatment (CT) group (n = 12). For the IIT group, blood glucose control was initiated with an artificial pancreas at initiation of surgery. Blood glucose was maintained at 100 mg/dl until 24 h postoperatively. Blood samples were collected to determine changes in serum cytokine levels over time.
Results
Patients’ characteristics did not differ significantly between groups. Blood glucose levels were significantly higher in the CT group after surgery. Serum levels of tumor necrosis factor-α, interleukin-6, and high-mobility group box 1 were higher in the CT group than in the IIT group.
Conclusions
Use of IIT in the artificial pancreas during the perioperative period signifiantly decreased the inflammatory response. Moreover, we did not find evidence of hypoglycemia in those treated with IIT. This suggests that use of IIT in an artificial pancreas can be safe and effective for critically ill patients.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Ni Choileain N, Redmond HP. Cell response to surgery. Arch Surg 2006;141:1132–1140.
Faist E, Schinkel C, Zimmer S. Update on the mechanisms of immune suppression of injury and immune modulation. World J Surg 1996;20:454–459.
Van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, et al. Intensive insulin therapy in the critically ill patients. N Engl J Med 2001;345:1359–1367.
Hagiwara S, Iwasaka H, Hasegawa A, Asai N, Noguchi T. Hyperglycemia contributes to cardiac dysfunction in a lipopolysaccha-ride-induced systemic inflammation model. Crit Care Med 2009;37:2223–2227.
Hagiwara S, Iwasaka H, Hasegawa A, Koga H, Noguchi T. Effects of hyperglycemia and insulin therapy on high mobility group box 1 in endotoxin-induced acute lung injury in a rat model. Crit Care Med 2008;36:2407–2413.
Finfer S, Chittock DR, Su SY, Blair D, Foster D, Dhingra V, et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med 2009;360:1283–1297.
Wiener RS, Wiener DC, Larson RJ. Benefits and risks of tight glucose control in critically ill adults: a meta-analysis. JAMA 2008;300:933–944.
Yamashita K, Yatabe T. Intraoperative glycemic control procedures and the use of an artificial pancreas. World J Gastroenterol 2009;15:4126–4131.
Wang H, Ma S. The cytokine storm and factors determining the sequence and severity of organ dysfunction in multiple organ dysfunction syndrome. Am J Emerg Med 2008;26:711–715.
Karlsson S, Pettilä V, Tenhunen J, Laru-Sompa R, Hynninen M, Ruokonen E. HMGB1 as a predictor of organ dysfunction and outcome in patients with severe sepsis. Intensive Care Med 2008;34:1046–1053.
Kyle UG, Coss Bu JA, Kennedy CE, Jefferson LS. Organ dysfunction is associated with hyperglycemia in critically ill children. Intensive Care Med 2010;36:312–320.
van Kuijk JP, Schouten O, Flu WJ, den Uil CA, Bax JJ, Poldermans D. Perioperative blood glucose monitoring and control in major vascular surgery patients. Eur J Vasc Endovasc Surg 2009;38:627–634.
Kawahito S, Kitahata H, Kitagawa T, Oshita S. Intensive insulin therapy during cardiovascular surgery. J Med Invest 2010;57:191–204.
Okabayashi T, Nishimori I, Yamashita K, Sugimoto T, Maeda H, Yatabe T, et al. Continuous postoperative blood glucose monitoring and control by artificial pancreas in patients having pancreatic resection: a prospective randomized clinical trial. Arch Surg 2009;144:933–937.
Okabayashi T, Nishimori I, Maeda H, Yamashita K, Yatabe T, Hanazaki K. Effect of intensive insulin therapy using a closed-loop glycemic control system in hepatic resection patients: a prospective randomized clinical trial. Diabetes Care 2009;32:1425–1427.
Kimura F, Shimizu H, Yoshidome H, Ohtsuka M, Kato A, Yoshitomi H, et al. Increased plasma levels of IL-6 and IL-8 are associated with surgical site infection after pancreaticoduodenectomy. Pancreas 2006;32:178–185.
Yamashita K, Okabayashi T, Yokoyama T, Yatabe T, Maeda H, Manabe M, et al. The accuracy of a continuous blood glucose monitor during surgery. Anesth Analg 2008;106:160–163.
Hanazaki K, Maeda H, Okabayashi T. Tight perioperative glycemic control using an artificial endocrine pancreas. Surg Today 2010;40:1–7.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Hasegawa, A., Iwasaka, H., Hagiwara, S. et al. Anti-inflammatory effects of perioperative intensive insulin therapy during cardiac surgery with cardiopulmonary bypass. Surg Today 41, 1385–1390 (2011). https://doi.org/10.1007/s00595-010-4458-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00595-010-4458-y