peroperatf gsemk konrol.ppt

In a retrospective study of 110 consecutive orthopaedic trauma patients, Karunakar found that a mean perioperative BG 220 mg/dl was associated with 7X higher risk of infection in patients with no known history of DM compared with matched diabetic patients. These data suggest that SIH can be a marker for severity of illness and degree of counter-regulatory hormone surge. One could also infer that previously diagnosed DM is in some way protective, as opposed to new-onset SIH (with no history of DM), Hyperglycemic patients have high circulating levels of proinflammatory cytokines, which can lead in turn to organ injury. Most prominent among these cytokines is tumor necrosis factor- , which is well documented to cause both lung and renal injury GV, defined as the degree of glucose level excursion over time, is increasingly linked to poor ICU and perioperative outcomes. In 2006, Egi et al retrospectively looked at both the mean glucose and SD of BG, as a marker of GV, in 7049 ICU patients. The authors found that both the mean and SD of BG were significantly associated with ICU mortality.54 Subsequently, in 2008, Krinsley showed that the SD of BG level was a predictor of mortality even within different ranges of mean glucose. They also demonstrated GV to be a stronger predictor of mortality than mean glucose. Hermanides et al were able to show that the combination of high GV and high mean BG values was associated with the highest overall ICU mortality. Interestingly, low GV was protective even in patients with high mean glucose levels. Their findings suggest that high mean glucose is less harmful when GV is low, and patients with identical mean glucose can have different mortality rates depending on their GV. Recommended glucose target ranges for intensive care patients and related subgroups PREOPERAT?F YAKLA?IM Diyabet tan?s? olmayan hastalar?n %25’inde elektif cerrahi ?nce kan ?ekeri de?erleri yüksektir Toplumda %2.8-10 oran?nda tan? konmam?? diyabetik vard