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Albert Starr - One of the best experts on this subject based on the ideXlab platform.

  • continuous Insulin Infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting
    The Journal of Thoracic and Cardiovascular Surgery, 2003
    Co-Authors: Anthony P Furnary, Gary L Grunkemeier, Ying Xing Wu, Kathryn J Zerr, Stephen O Bookin, Storm H Floten, Albert Starr
    Abstract:

    Abstract Objective: Diabetes mellitus is a risk factor for death after coronary artery bypass grafting. Its relative risk may be related to the level of perioperative hyperglycemia. We hypothesized that strict glucose control with a continuous Insulin Infusion in the perioperative period would reduce hospital mortality. Methods: All patients with diabetes undergoing coronary artery bypass grafting (n = 3554) were treated aggressively with either subcutaneous Insulin (1987-1991) or with continuous Insulin Infusion (1992-2001) for hyperglycemia. Predicted and observed hospital mortalities were compared with both internal and external (Society of Thoracic Surgeons 1996) multivariable risk models. Results: Observed mortality with continuous Insulin Infusion (2.5%, n=65/2612) was significantly lower than with subcutaneous Insulin (5.3%, n=50/942, P P P = .001). Conversely, cardiogenic shock, renal failure, reoperation, nonelective operative status, older age, concomitant peripheral or cerebral vascular disease, decreasing ejection fraction, unstable angina, and history of atrial fibrillation increased the risk of death. For external comparison, observed mortality with continuous Insulin Infusion was significantly less than that predicted by the model (observed/expected ratio 0.63, P P = .005) to the constellation of risk factors in the Society of Thoracic Surgeons risk model. Conclusion: Continuous Insulin Infusion eliminates the incremental increase in in-hospital mortality after coronary artery bypass grafting associated with diabetes. The protective effect of continuous Insulin Infusion may stem from the effective metabolic use of excess glucose to favorably alter pathways of myocardial adenosine triphosphate production. Continuous Insulin Infusion should become the standard of care for glycometabolic control in patients with diabetes undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg 2003;125:1007-21

  • continuous intravenous Insulin Infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures
    The Annals of Thoracic Surgery, 1999
    Co-Authors: Anthony P Furnary, Gary L Grunkemeier, Kathryn J Zerr, Albert Starr
    Abstract:

    BACKGROUND: Diabetes mellitus is a risk factor for deep sternal wound infection after open heart surgical procedures. We previously showed that elevated postoperative blood glucose levels are a predictor of deep sternal wound infection in diabetic patients. Therefore, we hypothesized that aggressive intravenous pharmacologic control of postoperative blood glucose levels would reduce the incidence of deep sternal wound infection. METHODS: In a prospective study of 2,467 consecutive diabetic patients who underwent open heart surgical procedures between 1987 and 1997, perioperative blood glucose levels were recorded every 1 to 2 hours. Patients were classified into two sequential groups: the control group included 968 patients treated with sliding-scale-guided intermittent subcutaneous Insulin injections (SQI); the study group included 1,499 patients treated with a continuous intravenous Insulin Infusion in an attempt to maintain a blood glucose level of less than 200 mg/dL. There were no differences between these groups with respect to age, sex, procedure, bypass time, antibiotic prophylaxis, or skin preparation methods. RESULTS: Compared with subcutaneous Insulin injections, continuous intravenous Insulin Infusion induced a significant reduction in perioperative blood glucose levels, which led to a significant reduction in the incidence of deep sternal wound infection in the continuous intravenous Insulin Infusion group (0.8% [12 of 1,499]) versus the intermittent subcutaneous Insulin injection group (2.0% [19 of 968], p = 0.01 by the chi2 test). Multivariate logistic regression revealed that continuous intravenous Insulin Infusion induced a significant decrease in the risk of deep sternal wound infection (p = 0.005; relative risk, 0.34), whereas obesity (p < 0.03; relative risk, 1.06) and use of an internal thoracic artery pedicle (p = 0.1; relative risk, 2.0) increased the risk of deep sternal wound infection. CONCLUSIONS: Use of perioperative continuous intravenous Insulin Infusion in diabetic patients undergoing open heart surgical procedures significantly reduces major infectious morbidity and its associated socioeconomic costs.

  • continuous intravenous Insulin Infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures
    The Annals of Thoracic Surgery, 1999
    Co-Authors: Anthony P Furnary, Gary L Grunkemeier, Kathryn J Zerr, Albert Starr
    Abstract:

    Abstract Background . Diabetes mellitus is a risk factor for deep sternal wound infection after open heart surgical procedures. We previously showed that elevated postoperative blood glucose levels are a predictor of deep sternal wound infection in diabetic patients. Therefore, we hypothesized that aggressive intravenous pharmacologic control of postoperative blood glucose levels would reduce the incidence of deep sternal wound infection. Methods . In a prospective study of 2,467 consecutive diabetic patients who underwent open heart surgical procedures between 1987 and 1997, perioperative blood glucose levels were recorded every 1 to 2 hours. Patients were classified into two sequential groups: the control group included 968 patients treated with sliding-scale–guided intermittent subcutaneous Insulin injections (SQI); the study group included 1,499 patients treated with a continuous intravenous Insulin Infusion in an attempt to maintain a blood glucose level of less than 200 mg/dL. There were no differences between these groups with respect to age, sex, procedure, bypass time, antibiotic prophylaxis, or skin preparation methods. Results . Compared with subcutaneous Insulin injections, continuous intravenous Insulin Infusion induced a significant reduction in perioperative blood glucose levels, which led to a significant reduction in the incidence of deep sternal wound infection in the continuous intravenous Insulin Infusion group (0.8% [12 of 1,499]) versus the intermittent subcutaneous Insulin injection group (2.0% [19 of 968], p = 0.01 by the χ 2 test). Multivariate logistic regression revealed that continuous intravenous Insulin Infusion induced a significant decrease in the risk of deep sternal wound infection ( p = 0.005; relative risk, 0.34), whereas obesity ( p p = 0.1; relative risk, 2.0) increased the risk of deep sternal wound infection. Conclusions . Use of perioperative continuous intravenous Insulin Infusion in diabetic patients undergoing open heart surgical procedures significantly reduces major infectious morbidity and its associated socioeconomic costs.

Wayne B Bequette - One of the best experts on this subject based on the ideXlab platform.

  • Multivariate statistical analysis to detect Insulin Infusion set failure
    Proceedings of the 2011 American Control Conference, 2011
    Co-Authors: Ruben Rojas, Winston Garcia-gabin, Wayne B Bequette
    Abstract:

    Multivariate statistical analysis techniques are applied to Insulin Infusion set failure detection (IISF), a challenging problem faced by individuals with type 1 diabetes that are on continuous Insulin Infusion pump therapy. Bivariate classification (BC), principal component analysis (PCA), and a combined approach were applied to simulated glucose concentrations for 10 patients, based on a nonlinear physiological model of Insulin and glucose dynamics. The PCA algorithm had fewer false alarms than BC, while detecting most drifting (ramp) Infusion set failures before complete failure occurred.

Anthony P Furnary - One of the best experts on this subject based on the ideXlab platform.

  • continuous Insulin Infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting
    The Journal of Thoracic and Cardiovascular Surgery, 2003
    Co-Authors: Anthony P Furnary, Gary L Grunkemeier, Ying Xing Wu, Kathryn J Zerr, Stephen O Bookin, Storm H Floten, Albert Starr
    Abstract:

    Abstract Objective: Diabetes mellitus is a risk factor for death after coronary artery bypass grafting. Its relative risk may be related to the level of perioperative hyperglycemia. We hypothesized that strict glucose control with a continuous Insulin Infusion in the perioperative period would reduce hospital mortality. Methods: All patients with diabetes undergoing coronary artery bypass grafting (n = 3554) were treated aggressively with either subcutaneous Insulin (1987-1991) or with continuous Insulin Infusion (1992-2001) for hyperglycemia. Predicted and observed hospital mortalities were compared with both internal and external (Society of Thoracic Surgeons 1996) multivariable risk models. Results: Observed mortality with continuous Insulin Infusion (2.5%, n=65/2612) was significantly lower than with subcutaneous Insulin (5.3%, n=50/942, P P P = .001). Conversely, cardiogenic shock, renal failure, reoperation, nonelective operative status, older age, concomitant peripheral or cerebral vascular disease, decreasing ejection fraction, unstable angina, and history of atrial fibrillation increased the risk of death. For external comparison, observed mortality with continuous Insulin Infusion was significantly less than that predicted by the model (observed/expected ratio 0.63, P P = .005) to the constellation of risk factors in the Society of Thoracic Surgeons risk model. Conclusion: Continuous Insulin Infusion eliminates the incremental increase in in-hospital mortality after coronary artery bypass grafting associated with diabetes. The protective effect of continuous Insulin Infusion may stem from the effective metabolic use of excess glucose to favorably alter pathways of myocardial adenosine triphosphate production. Continuous Insulin Infusion should become the standard of care for glycometabolic control in patients with diabetes undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg 2003;125:1007-21

  • continuous intravenous Insulin Infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures
    The Annals of Thoracic Surgery, 1999
    Co-Authors: Anthony P Furnary, Gary L Grunkemeier, Kathryn J Zerr, Albert Starr
    Abstract:

    BACKGROUND: Diabetes mellitus is a risk factor for deep sternal wound infection after open heart surgical procedures. We previously showed that elevated postoperative blood glucose levels are a predictor of deep sternal wound infection in diabetic patients. Therefore, we hypothesized that aggressive intravenous pharmacologic control of postoperative blood glucose levels would reduce the incidence of deep sternal wound infection. METHODS: In a prospective study of 2,467 consecutive diabetic patients who underwent open heart surgical procedures between 1987 and 1997, perioperative blood glucose levels were recorded every 1 to 2 hours. Patients were classified into two sequential groups: the control group included 968 patients treated with sliding-scale-guided intermittent subcutaneous Insulin injections (SQI); the study group included 1,499 patients treated with a continuous intravenous Insulin Infusion in an attempt to maintain a blood glucose level of less than 200 mg/dL. There were no differences between these groups with respect to age, sex, procedure, bypass time, antibiotic prophylaxis, or skin preparation methods. RESULTS: Compared with subcutaneous Insulin injections, continuous intravenous Insulin Infusion induced a significant reduction in perioperative blood glucose levels, which led to a significant reduction in the incidence of deep sternal wound infection in the continuous intravenous Insulin Infusion group (0.8% [12 of 1,499]) versus the intermittent subcutaneous Insulin injection group (2.0% [19 of 968], p = 0.01 by the chi2 test). Multivariate logistic regression revealed that continuous intravenous Insulin Infusion induced a significant decrease in the risk of deep sternal wound infection (p = 0.005; relative risk, 0.34), whereas obesity (p < 0.03; relative risk, 1.06) and use of an internal thoracic artery pedicle (p = 0.1; relative risk, 2.0) increased the risk of deep sternal wound infection. CONCLUSIONS: Use of perioperative continuous intravenous Insulin Infusion in diabetic patients undergoing open heart surgical procedures significantly reduces major infectious morbidity and its associated socioeconomic costs.

  • continuous intravenous Insulin Infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures
    The Annals of Thoracic Surgery, 1999
    Co-Authors: Anthony P Furnary, Gary L Grunkemeier, Kathryn J Zerr, Albert Starr
    Abstract:

    Abstract Background . Diabetes mellitus is a risk factor for deep sternal wound infection after open heart surgical procedures. We previously showed that elevated postoperative blood glucose levels are a predictor of deep sternal wound infection in diabetic patients. Therefore, we hypothesized that aggressive intravenous pharmacologic control of postoperative blood glucose levels would reduce the incidence of deep sternal wound infection. Methods . In a prospective study of 2,467 consecutive diabetic patients who underwent open heart surgical procedures between 1987 and 1997, perioperative blood glucose levels were recorded every 1 to 2 hours. Patients were classified into two sequential groups: the control group included 968 patients treated with sliding-scale–guided intermittent subcutaneous Insulin injections (SQI); the study group included 1,499 patients treated with a continuous intravenous Insulin Infusion in an attempt to maintain a blood glucose level of less than 200 mg/dL. There were no differences between these groups with respect to age, sex, procedure, bypass time, antibiotic prophylaxis, or skin preparation methods. Results . Compared with subcutaneous Insulin injections, continuous intravenous Insulin Infusion induced a significant reduction in perioperative blood glucose levels, which led to a significant reduction in the incidence of deep sternal wound infection in the continuous intravenous Insulin Infusion group (0.8% [12 of 1,499]) versus the intermittent subcutaneous Insulin injection group (2.0% [19 of 968], p = 0.01 by the χ 2 test). Multivariate logistic regression revealed that continuous intravenous Insulin Infusion induced a significant decrease in the risk of deep sternal wound infection ( p = 0.005; relative risk, 0.34), whereas obesity ( p p = 0.1; relative risk, 2.0) increased the risk of deep sternal wound infection. Conclusions . Use of perioperative continuous intravenous Insulin Infusion in diabetic patients undergoing open heart surgical procedures significantly reduces major infectious morbidity and its associated socioeconomic costs.

Winston Garcia-gabin - One of the best experts on this subject based on the ideXlab platform.

Mohammad Hassan Murad - One of the best experts on this subject based on the ideXlab platform.

  • continuous subcutaneous Insulin Infusion versus multiple daily injections in individuals with type 1 diabetes a systematic review and meta analysis
    Endocrine, 2017
    Co-Authors: Khalid Benkhadra, Fares Alahdab, Shrikant Tamhane, Rozalina G Mccoy, Larry J Prokop, Mohammad Hassan Murad
    Abstract:

    The relative efficacy of continuous subcutaneous Insulin Infusion and multiple daily injections in individuals with type 1 diabetes is unclear. We sought to synthesize the existing evidence about the effect of continuous subcutaneous Insulin Infusion on glycosylated hemoglobin, hypoglycemic events, and time spent in hypoglycemia compared to multiple daily injections. We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Database of Systematic Reviews, and Scopus from January 2008 through November 2015 for randomized controlled trials that enrolled children or adults with type 1 diabetes. Trials identified in a previous systematic review and published prior to 2008 were also included. We included 25 randomized controlled trials at moderate risk of bias. Meta-analysis showed a significant reduction in glycosylated hemoglobin in patients treated with continuous subcutaneous Insulin Infusion compared to multiple daily injections (mean difference 0.37; 95 % confidence interval, 0.24–0.51). This effect was demonstrated in both children and adults. There was no significant difference in minor or severe hypoglycemic events. Continuous subcutaneous Insulin Infusion was associated with lower incidence of nocturnal hypoglycemia. There was no significant difference in the time spent in hypoglycemia. In children and adults with type 1 diabetes and compared to multiple daily injections, continuous subcutaneous Insulin Infusion is associated with a modest reduction in glycosylated hemoglobin. There was no difference in severe or minor hypoglycemia, but likely a lower incidence of nocturnal hypoglycemia with continuous subcutaneous Insulin Infusion.