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Intensive Intraoperative Insulin Therapy versus Conventional Glucose Management during Cardiac Surgery
- George Carvalho, MD; and
- Thomas Schricker, MD, PhD
- From McGill University, Montréal, Québec H3A 1A1, Canada.
TO THE EDITOR:
Gandhi and colleagues (1) report the results of a randomized, controlled trial on the effect of intensive intraoperative insulin therapy after on-pump cardiac surgery. The authors conclude that the application of an insulin sliding scale that fails to consistently maintain blood glucose levels between 4.4 and 5.6 mmol/L (80 and 100 mg/dL) does not reduce mortality or morbidity in nondiabetic and diabetic patients after a variety of cardiac procedures. An increased incidence of death and stroke in the treatment group prompted the authors to caution against the routine use of insulin therapy during cardiac surgery.
Several aspects of the paper merit further comment. A study paradigm supposedly designed to examine the clinical value of a therapeutic concept in the operating room without considering important principles of surgical and anesthetic care is prone to flaws. Gandhi and colleagues' paper does not provide the required information for interpretation and understanding of outcomes observed in relatively few patients undergoing interventions of high surgical, physiological, and …
