Torsten Doenst, MD, Wolfgang Bothe, MD, Friedhelm Beyersdorf, MD

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Presentation transcript:

Therapy with insulin in cardiac surgery: controversies and possible solutions Torsten Doenst, MD, Wolfgang Bothe, MD, Friedhelm Beyersdorf, MD The Annals of Thoracic Surgery Volume 75, Issue 2, Pages S721-S728 (February 2003) DOI: 10.1016/S0003-4975(02)04698-2

Fig 1 Postoperative serum glucose (bullets), mean glucose infusion (open bars) and insulin infusion rates (black bars) of patients obtaining glucose insulin and potassium infusion according to a glucose-insulin-potassium (GIK) protocol described in the literature (A, phase 1, n = 9) or to a modified protocol (B, phase 2, n = 7) during the intensive care unit stay after aortocoronary bypass or valve surgery or both (see text for details). GIK was started after the first values were obtained. Values for serum glucose are mean ± SD. The Annals of Thoracic Surgery 2003 75, S721-S728DOI: (10.1016/S0003-4975(02)04698-2)

Fig 2 Postoperative serum potassium (triangles), mean potassium infusion (hatched bars), and mean insulin infusion rates (black bars) of patients obtaining glucose-insulin-potassium (GIK) infusion according to a GIK protocol described in the literature (phase 1, n = 9) during the intensive care unit stay after aortocoronary bypass or valve surgery or both (see text for details). GIK was started after the first values were obtained. Values for serum glucose are mean ± SD. The Annals of Thoracic Surgery 2003 75, S721-S728DOI: (10.1016/S0003-4975(02)04698-2)

Fig 3 Elimination of potassium from the plasma as a function of the initial insulin infusion rates of all patients treated with glucose-insulin-potassium (GIK). GIK-induced potassium elimination from plasma was calculated by subtracting the change in serum potassium during the first hour multiplied by the distribution of extracellular potassium (factor 0.25) and body weight from the infusion rate of potassium during the first hour. Note that there was no dose-response relationship. The Annals of Thoracic Surgery 2003 75, S721-S728DOI: (10.1016/S0003-4975(02)04698-2)

Fig 4 Postoperative serum glucose (bullets), mean glucose infusion (open bars), and insulin infusion rates (black bars) of patients obtaining high-dose insulin therapy (A, n = 5) or no metabolic therapy (B, n = 6) during the intensive care unit stay after aortocoronary bypass or valve surgery or both (see text for details). Insulin therapy was started after the first values were obtained. The single bullet on the left of the figure represents the preoperative serum glucose level. Values for serum glucose are mean ± SD. The Annals of Thoracic Surgery 2003 75, S721-S728DOI: (10.1016/S0003-4975(02)04698-2)

Fig 5 Serum concentrations of fatty acids (triangles), insulin (filled diamonds), and c-peptide (open diamonds) of patients receiving high-dose insulin therapy after aortocoronary or valve surgery or both. *p less than 0.05 versus time 0. Values are mean ± SD, n = 5. The Annals of Thoracic Surgery 2003 75, S721-S728DOI: (10.1016/S0003-4975(02)04698-2)