リケラボ論文検索は、全国の大学リポジトリにある学位論文・教授論文を一括検索できる論文検索サービスです。

リケラボ 全国の大学リポジトリにある学位論文・教授論文を一括検索するならリケラボ論文検索大学・研究所にある論文を検索できる

リケラボ 全国の大学リポジトリにある学位論文・教授論文を一括検索するならリケラボ論文検索大学・研究所にある論文を検索できる

大学・研究所にある論文を検索できる 「Surgical Site Infections and Inflammatory Reaction After Cardiac Surgery; Bedside Artificial Pancreas Versus Conventional Insulin Therapy: A Propensity Score–Matched Analysis」の論文概要。リケラボ論文検索は、全国の大学リポジトリにある学位論文・教授論文を一括検索できる論文検索サービスです。
リケラボ

コピーが完了しました

URLをコピーしました

論文の公開元へ論文の公開元へ
書き出し

Surgical Site Infections and Inflammatory Reaction After Cardiac Surgery; Bedside Artificial Pancreas Versus Conventional Insulin Therapy: A Propensity Score–Matched Analysis

Fujii, Tasuku Hirai, Takahiro Suzuki, Shogo Nishiwaki, Kimitoshi 名古屋大学

2022.03

概要

Objectives: Perioperative hyperglycemia is associated with poor postoperative recovery, including compromised immune function and increased risk of infection. A closed-loop glycemic control system (artificial pancreas) has demonstrated strict safe perioperative glycemic control without hypoglycemia risk. The authors hypothesized that the artificial pancreas would reduce surgical site infections (SSIs) and postoperative inflammatory reactions. This study aimed to assess the effect of the artificial pancreas on SSIs and C-reactive protein (CRP) levels after cardiac surgery.

Design: A single-center retrospective, propensity score–matched analysis.

Setting: A university hospital.

Participants: In total, 295 patients who underwent cardiovascular surgery with cardiopulmonary bypass were included.

Interventions: Patients were divided into two groups: artificial pancreas (target blood glucose: 120-150 mg/dL) and intravenous insulin infusion (conventional insulin therapy, target blood glucose: <200 mg/dL).

Measurements and Main Results: The differences in the incidence of SSIs and CRP levels between the two groups were assessed. After 1:1 propensity score matching based on their covariates, 101 matched patients were selected from each group. The incidence of SSIs was reduced by 3%, 5% (conventional insulin therapy), and 2% (artificial pancreas), but the reduction was not statistically significant (p = 0.45). The postoperative maximum CRP level was significantly lower in the artificial pancreas group than in the conventional insulin therapy group, mean (standard deviation)14.53 (5.64) mg/dL v 16.57 (5.58) mg/dL; p = 0.01.

Conclusions: The artificial pancreas did not demonstrate a significant reduction in the incidence of SSIs. However, the artificial pancreas was safe and suppressed postoperative inflammation compared with conventional insulin therapy.

論文の公開元へ

この論文で使われている画像

関連論文

関連論文をもっと見る

参考文献

1. Peacock TS. Perioperative Hyperglycemia: A Literature Review. AORN J 2019;109:80–86.

2. Ramos M, Khalpey Z, Lipsitz S, et al. Relationship of perioperative hyperglycemia and postoperative infections in patients who undergo general and vascular surgery. Ann Surg 2008;248:585–591.

3. Kwon S, Thompson R, Dellinger P, et al. Importance of perioperative glycemic control in general surgery: a report from the Surgical Care and Outcomes Assessment Program. Ann Surg 2013;257:8–14.

4. Hanazaki K, Maeda H, Okabayashi T. Relationship between peri-operative glycemic control and postoperative infections. World J Gastroenterol 2009;15:4122–4125.

5. Vogt AP, Bally L. Perioperative glucose management: Current status and future directions. Best Pract Res Clin Anaesthesiol 2020;34:213–224.

6. Tsai LL, Jensen HA, Thourani VH. Intensive Glycemic Control in Cardiac Surgery. Curr Diab Rep 2016;16:25.

7. Berríos-Torres SI, Umscheid CA, Bratzler DW, et al. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA Surg 2017;152:784–791.

8. Ban KA, Minei JP, Laronga C, et al. American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016 Update. J Am Coll Surg 2017;224:59–74.

9. Lazar HL, McDonnell M, Chipkin SR, et al. Society of Thoracic Surgeons Blood Glucose Guideline Task Force: The Society of Thoracic Surgeons practice guideline series: Blood glucose management during adult cardiac surgery. Ann Thorac Surg 2009;87:663–669.

10．Cardiothoracic Interdisciplinary Research Network. National survey of variations in practice in the prevention of surgical site infections in adult cardiac surgery, United Kingdom and Republic of Ireland. J Hosp Infect 2020;106:812–819.

11. Andrade LS, Siliprandi EMO, Karsburg LL, et al. Surgical Site Infection Prevention Bundle in Cardiac Surgery. Arq Bras Cardiol 2019;112:769–774.

12. Knapik P, Nadziakiewicz P, Urbanska E, et al. Cardiopulmonary bypass increases postoperative glycemia and insulin consumption after coronary surgery. Ann Thorac Surg 2009;87:1859–1865.

13. Siddiqui KM, Asghar MA, Khan MF, et al. Perioperative glycemic control and its outcome in patients following open heart surgery. Ann Card Anaesth 2019;22:260–264.

14. Stamou SC, Nussbaum M, Carew JD, et al. Hypoglycemia with intensive insulin therapy after cardiac surgery: predisposing factors and association with mortality. J Thorac Cardiovasc Surg 2011;142:166–173.

15. Johnston LE, Kirby JL, Downs EA, et al. Postoperative Hypoglycemia Is Associated With Worse Outcomes After Cardiac Operations. Ann Thorac Surg 2017;103:526–532.

16. Okabayashi T, Nishimori I, Yamashita K, 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.

17. Hanazaki K, Maeda H, Okabayashi T. Tight perioperative glycemic control using an artifi cial endocrine pancreas. Surg Today 2010;40:1–7.

18. Yatabe T, Yamazaki R, Kitagawa H, et al. The evaluation of the ability of closedloop glycemic control device to maintain the blood glucose concentration in intensive care unit patients. Crit Care Med 2011;39:575–578.

19. Tsukamoto Y, Okabayashi T, Hanazaki K. Progressive artificial endocrine pancreas: the era of novel perioperative blood glucose control for surgery. Surg Today 2011;41:1344–1351.

20. Hanazaki K, Munekage M, Kitagawa H, et al. Current topics in glycemic control by wearable artificial pancreas or bedside artificial pancreas with closed-loop system. J Artif Organs 2016;19:209–218.

21. Shin U, Naoko H, Michinori T, et al. Utility of bedside artificial pancreas for postoperative glycemic control in cardiac surgery. J Artif Organs (in press).

22. Tamura T, Yatabe T, Namikawa T, et al. Glucose control using a closed-loop device decreases inflammation after cardiovascular surgery without increasing hypoglycemia risk. J Artif Organs 2019;22:154–159.

23. Kellum JA, Lameire N; KDIGO AKI Guideline Work Group. Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1). Crit Care 2013;17:204.

24. Kotagal M, Symons RG, Hirsch IB, et al. Perioperative hyperglycemia and risk of adverse events among patients with and without diabetes. Ann Surg 2015;261:97–103.

25. Nair BG, Neradilek MB, Newman SF, et al. Association between acute phase perioperative glucose parameters and postoperative outcomes in diabetic and nondiabetic patients undergoing non-cardiac surgery. Am J Surg 2019;218:302–310.

26. Van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in critically ill patients. N Engl J Med 2001;345:1359–1367.

27. Egi M, Bellomo R, Stachowski E, et al. Variability of blood glucose concentration and short-term mortality in critically ill patients. Anesthesiology 2006;105:244–252.

28. Rassias AJ. Intraoperative management of hyperglycemia in the cardiac surgical patient. Semin Thorac Cardiovasc Surg 2006;18:330–338.

29. McConnell YJ, Johnson PM, Porter GA. Surgical site infections following colorectal surgery in patients with diabetes: association with postoperative hyperglycemia. J Gastrointest Surg 2009;13:508–515

参考文献をもっと見る