286 research outputs found
Perioperative hyperglycemia and neurocognitive outcome after surgery: a systematic review
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introDUction: Preliminary evidence suggest a possible relationship between perioperative
hyperglycemia, postop- erative delirium (PoD) or cognitive dysfunction (PocD). We aim to present
the available clinical evidence related to chronic (i.e. diabetes mellitus) or acute perioperative
hyperglycemia as risk factors for PoD/PocD.
eviDence acQUisition: a literature search of eMBase (via ovid, 1974-present) online medical
database and MeDline (via PubMed or ovid, 1946-present) was performed. all types of clinical
studies including randomized con- trolled trials, prospective, as well as retrospective cohort
studies were screened. clinical studies that reported original information on the relationship
between diabetes mellitus (DM) and/or acute perioperative abnormal glucose levels and PoD or PocD
were selected. reviews and editorials (i.e. articles not presenting original preclinical or
clinical research) were excluded and case-reports were not considered for analysis.
eviDence sYntHesis: our search resulted in 2356 papers for screening, from which we selected 29
studies that met our inclusion criteria. DM was investigated in 24 observational papers, acute
perioperative hyperglycemia in six obser- vational studies and two randomized controlled trials
examined the effect of perioperative glucose lowering on PoD/ PocD. Diabetes was associated with
PoD or PocD in 18/24 observational studies and 6/6 of the included observational studies found that
perioperative hyperglycemia was associated with PoD/PocD, independent of diabetes. the two ran-
domized controlled trials had a different trial design and reported conflicting results.
conclUsions: according to the available evidence, DM and acute perioperative hyperglycemia may be
associated with an increased risk for PoD/PocD. these conclusions are based mostly on observational
studies and deserve more and dedicated research. this systematic review may direct the design of
future studies.
(Cite this article as: Hermanides J, Qeva e, Preckel B, Bilotta F. Perioperative hyperglycemia and
neurocognitive outcome after surgery: a systematic review. Minerva anestesiol 2018;84:1178-88. Doi:
10.23736/s0375-9393.18.12400-X)
Key words: Hyperglycemia - cognitive dysfunction - Delirium - Diabetes mellitus - Postoperative
complications
The incidence of diabetes mellitus following pulmonary embolism: a retrospective cohort study
No full textSechterberger MK, Hutten BA, Hermanides J, Cohn DM, Hoekstra JBL, Kamphuisen PW, DeVries JH. The incidence of diabetes mellitus following pulmonary embolism: a retrospective cohort study. J Thromb Haemost 2012; 10: 262830
Coronary Atheroma Regression With Evolocumab in Stable and Unstable Coronary Syndromes
No full textStephen J. Nicholls, Yu Kataoka, Steven E. Nissen, Francesco Prati, Stephan Windecker, Rishi Puri, Thomas Hucko, Daniel Aradi, Jean-Paul R. Herrman, Renicus S. Hermanides, Bei Wang, Huei Wang, Julie Butters, Giuseppe Di Giovanni, Stephen Jones, Gianluca Pompili, Kathy Wolski, Peter J. Psalti
Bridging the gap: Current and future insights for improving suboptimal platelet inhibition in STEMI
No full textAntiplatelet therapy is one of the cornerstones in the acute treatment of patients with ST-elevation myocardial infarction (STEMI) who undergo primary percutaneous coronary intervention (PCI). However, hemodynamic changes and delayed intestinal absorption of P2Y12 inhibitors leads to a delay in the onset of antiplatelet effects resulting in a gap of platelet inhibition. Several strategies have been proposed to bridge this gap, such as pre-hospital administration of antiplatelet therapy, higher loading doses of P2Y12 inhibitors, crushing or chewing tablets, subcutaneous or intravenous administration of platelet inhibitors, or use of pain relievers alternative to opioids that do not delay intestinal absorption of oral platelet inhibitors. These strategies may improve platelet inhibition with the goal of optimizing clinical outcomes in the acute phase of STEMI. In this review we present current and future insights for bridging the gap in platelet inhibition in STEMI patients undergoing primary PCI
Everolimus-eluting bioresorbable vascular scaffold in daily clinical practice: A single-centre experience
No full textBackground Recent evidence has raised concerns regarding the safety of the everolimus-eluting bioresorbable vascular scaffold (E-BVS) (Absorb, Abbott Vascular, Santa Clara, CA, USA). Following these data, the use of this device has diminished in the Netherlands; however, daily practice data are limited. Therefore we studied the incidence of safety and efficacy outcomes with this device in daily clinical practice in a single large tertiary centre in the Netherlands. Methods All E-BVS treated patients were included in this analysis. The primary endpoint was target lesion failure (TLF), a composite of cardiac death, target vessel non-fatal myocardial infarction (TV-MI) and clinically-driven target lesion revascularisation (TLR). The secondary endpoint was the incidence of definite scaffold thrombosis. Results Between October 2013 and January 2017, 105 patients were treated with 147 E-BVS. This population contained 42 (40%) patients with diabetes mellitus and 43 (40.9%) undergoing treatment for acute coronary syndrome, and thus represents a high-risk patient cohort. Mean follow-up was 19.8 months. Intravascular imaging guidance during scaffold implantation was used in 64/105 (43.5%) patients. The primary endpoint (TLF) occurred in 3 (2.9%) patients. All-cause mortality and cardiac mortality occurred in 2 (2%) and 0 (0%) patients respectively. TV-MI occurred in 2 patients (1.9%): both were periprocedural and not related to the BVS implantation. TLR occurred in 1 patient (1.0%) during follow-up. No definite scaffold thrombosis occurred during follow-up. Conclusion This single-centre study examining the real-world experience of E-BVS implantation in a high-risk population shows excellent procedural safety and long-term clinical outcomes
Hyperglycemia, hypoglycemia, and glycemic complexity are associated with worse outcomes after surgery
No full textPurpose: The purpose of this study was to determine if glycemic complexity, along with hypoglycemia and hyperglycemia, was associated with worse outcomes after cardiac surgery. Materials and methods: We conducted a retrospective analysis of 970 patients who had insulin infusions designed to keep blood glucose levels between 80 and 110 mg-dL. Glycemic complexity was calculated using jackknifed approximate entropy. Logistic regression was used to adjust for confounders. Results: A total of 495 patients (51percent) developed complications, and 32 patients (3.3percent) died. Along with older age, comorbidities, and complicated surgeries, any hypoglycemia (glucose 71 mg-dL) and the number of glucose values greater than 140 mg-dL were independent predictors of complications. Increased risk of mortality, after adjusting for other risk factors, was associated with older age, longer perfusion time, receiving intraoperative transfusions, and greater jackknifed approximate entropy of the glucose time series. Conclusion: We found that hypoglycemia (glucose 71 mg-dL) and hyperglycemia (glucose 140 mg-dL) were associated with increased risk of complications, whereas greater complexity of the glucose time series was associated with mortality. © 2014 Elsevier Inc.Amir J, 2011, CELL IMMUNOL, V272, P45, DOI 10.1016-j.cellimm.2011.09.008; Bagshaw SM, 2009, CRIT CARE, V13, DOI 10.1186-cc7921; Cochran WG, 1967, SAMPLING TECHNIQUES, P154; Cueni-Villoz N, 2011, CRIT CARE MED, V39, P2225, DOI 10.1097-CCM.0b013e31822572c9; D'Ancona G, 2011, EUR J CARDIO-THORAC, V40, P360, DOI 10.1016-j.ejcts.2010.11.065; Egi M, 2010, MAYO CLIN PROC, V85, P217, DOI 10.4065-mcp.2009.0394; Engoren M, 2009, J APPL PHYSIOL, V106, P766, DOI 10.1152-japplphysiol.90575.2008; Finfer S, 2009, NEW ENGL J MED, V360, P1283, DOI 10.1056-NEJMoa0810625; Finney SJ, 2003, JAMA-J AM MED ASSOC, V290, P2041, DOI 10.1001-jama.290.15.2041; Hermanides J, 2010, CRIT CARE MED, V38, P838, DOI 10.1097-CCM.0b013e3181cc4be9; Hermanides J, 2010, CRIT CARE MED, V38, P1430, DOI 10.1097-CCM.0b013e3181de562c; Hollingdal M, 2000, DIABETES, V49, P1334, DOI 10.2337-diabetes.49.8.1334; Kemeny SF, 2011, J BIOMECH, V44, P1927, DOI 10.1016-j.jbiomech.2011.04.026; Krinsley JS, 2004, MAYO CLIN PROC, V79, P992; Krinsley James Stephen, 2009, J Diabetes Sci Technol, V3, P1292; Lazar HL, 2009, ANN THORAC SURG, V87, P663, DOI 10.1016-j.athoracsur.2008.11.011; Li J, 2006, PHYS REV E, V73, DOI 10.1103-PhysRevE.73.052902; Mackenzie IMJ, 2011, INTENS CARE MED, V37, P435, DOI 10.1007-s00134-010-2103-2; Meyfroidt G, 2011, INTENS CARE MED, V37, P1151, DOI 10.1007-s00134-011-2159-7; Meyfroidt G, 2010, CRIT CARE MED, V38, P1021, DOI 10.1097-CCM.0b013e3181cf710e; Pappada SM, 2011, DIABETES TECHNOL THE, V13, P135, DOI 10.1089-dia.2010.0104; Pincus SM, 2008, J PSYCHIATR RES, V42, P337, DOI 10.1016-j.jpsychires.2007.01.001; Suh SW, 2007, GLIA, V55, P1280, DOI 10.1002-glia.20440; Van den Berghe G, 2006, NEW ENGL J MED, V354, P449, DOI 10.1056-NEJMoa052521; Van den Berghe G, 2001, NEW ENGL J MED, V345, P1359, DOI 10.1056-NEJMoa011300; Wang X, 2009, THESIS U VIRGINIA; Wessel N, 2000, PHYS REV E, V61, P733, DOI 10.1103-PhysRevE.61.7330
Factors associated with deferred lesion failure following fractional flow reserve assessment in patients with diabetes mellitus
No full textObjective: To explore the predictors of deferred lesion failure (DLF) in patients with diabetes mellitus (DM) and lesions with a fractional flow reserve (FFR) >0.80 and to examine whether a predictive relationship between negative FFR values (>0.80–1.00) and DLF exists. Background: DM is associated with rapidly progressive atherosclerosis and predictors of DLF in FFR negative lesions in this high-risk group are unknown. Methods: All DM patients who underwent FFR-assessment between 1/01/2010 and 31/12/2013 were included, and followed until 1/7/2015. Patients carrying ≥1 FFR negative lesion(s) were assessed for DLF, and multivariate models used to identify independent factors associated with DLF. Results: A total of 205 patients with 252 FFR >0.80 lesions were identified. At a mean follow-up of 3.1 ± 1.4 years, DLF occurred in 29/205 (14.1%) patients, 31/252 (12.3%) lesions. Using marginal Cox regression multivariate analysis, insulin requiring DM [HR 2.24 (95%CI; 1.01–4.95), P = 0.046] and prior revascularization [HR 2.70 (95%CI 1.21–6.01), P = 0.015] were identified as being associated with a higher incidence of DLF. Absolute FFR values in FFR negative lesions in DM patients are not predictive of DLF (receiver operating characteristics curve analysis: area under the curve: 0.57 ± 0.06, 95%CI 0.46–0.69). Conclusions: In DM patients with FFR negative lesions, insulin requiring DM and prior revascularization are predictors for DLF. In contrast to non-DM patients, no predictive relationship between absolute negative FFR values (ranging >0.80–1.00) and the risk of DLF exists in DM patients
Measure for measure: consequences, detection and treatment of hyperglycaemia
No full textPissing evil is how sir Thomas Willis in the 17th century described the high concentrations of glucose found in the urine of patients. The sweet urine described by dr. Willis was the result of pathologically elevated concentrations of glucose in the blood called hyperglycaemia. In those days, hyperglycaemia would eventually mean certain death. Since then we have come a long way, but are still left with questions on the consequences of hyperglycaemia and how we best measure it in order to take the appropriate measures. In this thesis, several studies are presented that investigated the consequences, detection and treatment of hyperglycaemia
Sensor-augmented insulin pump more effective than multiple daily insulin injections for reducing HbA1C in people with poorly controlled type 1 diabetes
No full textMay frequency of blood glucose measurement be blurring the association between mean absolute glucose change per hour and mortality? Reply
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