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8. Surgery of the Diaphragm

Author

Bravo Iñiguez, Carlos E., primary, Martinez, Mauricio Perez, additional, Wiener, Daniel C., additional, and Jaklitsch, Michael T., additional

Published
2016
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9. Contributors

Author

Abbott, Brian G., primary, Abbott, J. Dawn, additional, Adams, David H., additional, Al-Atassi, Talal, additional, Al-Dameh, Ali, additional, Allen, Mark S., additional, Altorki, Nasser K., additional, Anand, Jatin, additional, Anderson, Robert H., additional, Anraku, Masaki, additional, Anyanwu, Anelechi C., additional, Arora, Amit, additional, Austin, Erle H., additional, Awtry, Eric H., additional, Bacha, Emile A., additional, Backhus, Leah M., additional, Bagai, Jayant, additional, Baillot, Richard, additional, Baird, Christopher W., additional, Barron, David J., additional, Bavaria, Joseph E., additional, Bernal, Jose M., additional, Bianco, Valentino J., additional, Bichell, David P., additional, Birgisson, Sigurbjorn, additional, Blackburn, Nick J.R., additional, Bonatti, Johannes, additional, Boodhwani, Munir, additional, Bove, Edward L., additional, Brawn, William J., additional, Brizard, Christian P., additional, Brothers, Julie A., additional, Brown, Lisa M., additional, Bryant, Ayesha S., additional, Burkhart, Harold M., additional, Caldarone, Christopher A., additional, Cannon, Jeremy W., additional, Carr, Justine M., additional, Castelvecchio, Serenella, additional, Castillo, Javier G., additional, Cecchin, Frank, additional, Cerfolio, Robert J., additional, Chahine, A. Alfred, additional, Chaikof, Elliot L., additional, Chan, Vincent, additional, Chaudhry, Sunit-Preet, additional, Chen, Frederick Y., additional, Chen, Stuart H., additional, Cheng, Aaron M., additional, Chien, Victor, additional, Chin, Alvin J., additional, Chin, Cynthia S., additional, Chiu, Peter, additional, Cleveland, Joseph C., additional, Cohn, Lawrence H., additional, Cohn, William E., additional, Colson, Yolonda L., additional, Colucci, Wilson S., additional, Cook, Andrew C., additional, Coselli, Joseph S., additional, Crawford, Todd C., additional, Culligan, Melissa, additional, Dagenais, François, additional, Damiano, Ralph J., additional, D'Amico, Thomas A., additional, Dartevelle, Philippe G., additional, David, Tirone E., additional, D'Cunha, Jonathan, additional, de la Cruz, Kim I., additional, Dearani, Joseph A., additional, DeArmond, Daniel T., additional, del Nido, Pedro J., additional, DeMeester, Tom R., additional, Demers, Philippe, additional, Demmy, Todd L., additional, Dexter, Elisabeth U., additional, Dhupar, Rajeev, additional, DiNardo, James A., additional, Doyle, Thomas P., additional, Ehsan, Afshin, additional, Khoury, Gebrine El, additional, Ellis, Ethan R., additional, Elmadhun, Nassrene Y., additional, Emani, Sitaram M., additional, Erasmus, Jeremy J., additional, Fauza, Dario O., additional, Fein, Adam S., additional, Fiedler, Amy G., additional, Foppa, Murilo, additional, Freeman, Rosario V., additional, Friedberg, Joseph, additional, Friscia, Michael, additional, Fynn-Thompson, Francis, additional, Gaynor, J. William, additional, Ge, Liang, additional, Geva, Tal, additional, Gheewala, Neil M., additional, Gillinov, A. Marc, additional, Glower, Donald D., additional, Goldstone, Andrew B., additional, Groth, Shawn S., additional, Grover, Frederick L., additional, Guccione, Julius, additional, Ha, Richard, additional, Hammon, John W., additional, Hanna, Jennifer M., additional, Harrison, David G., additional, Hauser, Thomas H., additional, Henn, Matthew C., additional, Hirsch-Romano, Jennifer C., additional, Hoang, Chuong D., additional, Hofstetter, Wayne L., additional, Honjo, Osami, additional, Huynh, Tam T., additional, Bravo, Carlos E., additional, Iturra, Sebastian, additional, Jacobs, Jeffrey P., additional, Jacobs, Marshall L., additional, Jaklitsch, Michael T., additional, Jamieson, Stuart W., additional, Jarrar, Doraid, additional, Jarrett, Craig M., additional, Jones, David R., additional, Josephson, Mark E., additional, Joventino, Lilian P., additional, Juraszek, Amy L., additional, Kachala, Stefan S., additional, Kaiser, Larry R., additional, Kanter, Kirk R., additional, Karamichalis, John M., additional, Kaza, Aditya K., additional, Kemp, Clinton D., additional, Kernstine, Kemp H., additional, Keshavamurthy, Suresh, additional, Keshavjee, Shaf, additional, Kozik, Deborah J., additional, Laham, Roger J., additional, Landzberg, Michael J., additional, Lawrance, Christopher P., additional, Lee, Lawrence S., additional, LeMaire, Scott A., additional, Levitsky, Sidney, additional, Levy, Jerrold H., additional, Linden, Philip A., additional, Liptay, Michael J., additional, Litle, Virginia R., additional, Rito, Mauro Lo, additional, Luketich, James D., additional, Lytle, Bruce W., additional, Madani, Michael, additional, Mahmood, Feroze, additional, Mallidi, Hari R., additional, Mangi, Abeel A., additional, Manning, Warren J., additional, Marom, Edith M., additional, Marshall, Audrey C., additional, Martinez, Mauricio Perez, additional, Mascio, Christopher E., additional, Mason, David P., additional, Mathisen, Douglas J., additional, Mattox, Kenneth L., additional, Matyal, Robina, additional, McCully, James D., additional, McKenna, Robert J., additional, McNamee, Ciaran, additional, McNeil, Jeffrey D., additional, Menicanti, Lorenzo, additional, Mestres, Carlos A., additional, Mettler, Bret A., additional, Meyers, Bryan Fitch, additional, Mick, Stephanie, additional, Mihaljevic, Tomislav, additional, Milano, Carmelo A., additional, Miller, D. Craig, additional, Miller, Daniel L., additional, Miller, Meagan M., additional, Mitchell, John D., additional, Montealegre-Gallegos, Mario, additional, Moores, Neal G., additional, Murphy, Charles E., additional, Murthy, Raghav A., additional, Murthy, Sudish C., additional, Mussot, Sacha, additional, Naka, Yoshifumi, additional, Nathan, Meena, additional, Newman, Kurt D., additional, Nwogu, Chukwumere, additional, Odegard, Kirsten C., additional, Oh, Daniel S., additional, Ohye, Richard G., additional, Onaitis, Mark W., additional, Ostojic, Aleksandra, additional, Ott, Harald C., additional, Ouzounian, Maral, additional, Owais, Khurram, additional, Padalino, Massimo, additional, Papadakis, Konstantinos, additional, Patterson, G.A., additional, Patz, Edward F., additional, Paul, Subroto, additional, Pennathur, Arjun, additional, Perry, Yaron, additional, Piana, Robert N., additional, Pigula, Frank A., additional, Pinto, Duane S., additional, Pomar, Jose L., additional, Preventza, Ourania, additional, Pua, Bradley, additional, Puri, Varun, additional, Quinonez, Luis, additional, Raja, Siva, additional, Ratcliffe, Mark, additional, Reardon, Michael J., additional, Reilly, John J., additional, Reyes, Karl G., additional, Rice, Thomas W., additional, Robbins, Robert C., additional, Rocco, Gaetano, additional, Rubens, Fraser D., additional, Ruel, Marc, additional, Rusch, Valerie W., additional, Sabe, Ashraf A., additional, Said, Sameh M., additional, Samson, Pamela P., additional, Sanders, Stephen P., additional, Sarin, Eric L., additional, Schaff, Hartzell V., additional, Schaheen, Lara W., additional, Seder, Christopher W., additional, Sellke, Frank W., additional, Sepesi, Boris, additional, Shahani, Rohit, additional, Shamberger, Robert C., additional, Shapira, Oz M., additional, Shay, Steven S., additional, Shrager, Joseph B., additional, Si, Ming-Sing, additional, Singh, Steve K., additional, Smith, Peter K., additional, Sodha, Neel R., additional, Solaro, R. John, additional, Soukiasian, Harmik J., additional, Spurlock, David, additional, Stellin, Giovanni, additional, Stiles, Brendon M., additional, Straznicka, Michaela, additional, Stump, David A., additional, Sugarbaker, David J., additional, Suuronen, Erik J., additional, Svensson, Lars G., additional, Swanson, Scott J., additional, Szeto, Wilson Y., additional, Taghavi, Sharven, additional, Takayama, Hiroo, additional, Takeda, Koji, additional, Thiagarajan, Ravi R., additional, Thistlethwaite, Patricia A., additional, Thourani, Vinod H., additional, Toeg, Hadi D., additional, Tong, Michael Z., additional, Truesdell, Alexander G., additional, Tsai, Peter I., additional, Urschel, Harold C., additional, Valente, Anne Marie, additional, Vallabhajosyula, Prashanth, additional, Velotta, Jeffrey B., additional, Vida, Vladimiro, additional, Vlahakes, Gus J., additional, Voisine, Pierre, additional, Wall, Matthew J., additional, Walsh, Garrett L., additional, Walters, Dustin M., additional, Wei, Benjamin, additional, Welsby, Ian J., additional, Westfall, Margaret V., additional, Wiener, Daniel C., additional, Wilcox, Benson R., additional, Williams, Judson B., additional, Wilson, Jay M., additional, Woo, Y. Joseph, additional, Wood, Douglas E., additional, Wylie, John V., additional, Yang, Stephen C., additional, Yendamuri, Sai, additional, Yeon, Susan B., additional, and Zimetbaum, Peter J., additional

Published
2016
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10. Contributors

Author

Abbott, Brian G., Abbott, J. Dawn, Adams, David H., Alarcon, Emilio I., Al-Atassi, Talal, Al-Dameh, Ali, Allen, Mark S., Altorki, Nasser K., Anderson, Robert H., Anraku, Masaki, Antonoff, Mara B., Anyanwu, Anelechi C., M. Argote-Greene, Luis, B. Atkinson, Douglas, Awtry, Eric Herschel, Ayalon, Nir, Bacha, Emile A., Bagai, Jayant, Baillot, Richard, Baird, Christopher W., Wyler von Ballmoos, Moritz C., Barron, David J., Bavaria, Joseph E., J. Benoit, Patrick, Bernal, Jose M., P. Bichell, David, Billaud, Marie, Mahmood, Syed Usman Bin, Boodhwani, Munir, Bostock, Ian C., Bradley, Matthew J., Brawn, William J., Brizard, Christian P., Brothers, Julie A., Brown, Alana, Brown, Morgan Leigh, Bueno, Raphael, Burkhart, Harold M., Burns, Daniel J.P., Burt, Bryan M., Callahan, Ryan M., Cannon, Jeremy W., Capaccione, Kathleen M., Castelvecchio, Serenella, J. Cerfolio, Robert, Chaikof, Elliot L., Cham, Matthew D., Chang, Stephanie H., Chauvette, Vincent, Chin, Cynthia S., Chiu, Peter, Choi, Perry S, Clarke, John-Ross D, Cleveland, Joseph C., Colson, Yolonda L., Cohn, William E., Cook, Andrew C., Coselli, Joseph S., Coster, Jenalee N., Cui, Hao, Dagenais, Francois, Damiano, Ralph J., D'Amico, Thomas A., David, Tirone E., d'Avila, Andre, Azevedo, MD, Ivan Salgado de, Dearani, Joseph A., del Nido, Pedro J., Demehri, Farokh R., Demers, Philippe, Demmy, Todd Lyle, Dexter, Elisabeth U., Dezube, Aaron R., Dhupar, Rajeev, DiMaio, J. Michael, DiMaria, Matthew Christopher, DiNardo, James A., Doenst, Torsten, Dolan, Daniel Powell, Duarte, Paula, d'Udekem, Yves, Edelman, J. James, Ehsan, Afshin, Eickhoff, Emily R., Elde, Stefan, El Khoury, Gebrine, Elmadhun, Nassrene, Emani, Sitaram M., Fatima, Huma, Fauza, Dario O., Feins, Eric Norton, Feldman, Hope A., Figueroa, Paula Ugalde, Freeman, Rosario V., Friedberg, Joseph S., Fynn-Thompson, Francis, Gaudino, Mario F.L., Gaynor, J. William, Ge, Liang, Geraci, Travis C., Gergen, Anna K., Geva, Tal, Ghadimi, Kamrouz, Ghanayem, Nancy S., Ghanta, Ravi K., Gillinov, A. Marc, Glower, Donald D., Goldstone, Andrew B., Gregor, Alexander, Grimm, Joshua C., Groner, Lauren K., Grover, Frederick L., Guariento, Alvise, Guccione, Julius, Guimaron, Samantha, Gunasingha, Rathnayaka M. Kalpanee D., Halas, Monika, Hammer, Peter E., Hammon, John W., Guo, Ming Hao, Harris, Andrew W., Harrison, David G., Hauser, Thomas H., Heiden, Brendan T., Henschke, Claudia I., Hiesinger, William, Hoang, Chuong D., Hobbs, Reilly D., Hoffman, George M., Hofstetter, Wayne L., Hoganson, David M., Hraska, Viktor, Hughes, G. Chad, Hussien, Amira, Bao, Giang Thanh Huynh, Ibrahim, Marina, Iyengar, Ajay J., Jaklitsch, Michael T., Jennings, Russell, Jones, David R., Jordan, Sean A., Juraszek, Amy L., Kaiser, Larry R., Kaku, Yuji, Kaproth-Joslin, Katherine, Kays, David W., Kaza, Aditya K., Kent, Amie J., Kernstine, Kemp H., Keshavjee, Shaf, KÖksoy, Cuneyt, Kurlansky, Paul, Kwon, Michael H., Larnard, Emily A., LaPar, Damien J., Lau, Christopher, LeMaire, Scott A., Levitsky, Sidney, Levy, Jerrold H., Liang, Patric, Lighter, Melani K., Linden, Philip A., Liptay, Michael J., Litle, Virginia R., Locke, Andrew H., Luketich, James D., Lytle, Bruce W., Mack, Michael J., Madani, Michael M., Mahmood, Feroze, Maisano, Francesco, Mallidi, Hari R., Mamoun, Negmeldeen, Mangi, Abeel A., Manning, Warren J., Marshall, M. Blair, Mason, David P., Mathisen, Douglas J., Matte, Gregory S., Mattox, Kenneth L., Matyal, Robina, McCully, James D., McGilvray, Martha M.O., McKenna, Robert J., McLennan, Daniel, Menicanti, Lorenzo, Mestres, Carlos A., Meyers, Bryan F., Miller, Daniel L., Miller, D. Craig, Miller, Meagan M., Mitchell, John D., Mufarrih, Syed Hamza, Murthy, Raghav A., Naka, Yoshifumi, Nathan, Meena, Newman, Kurt, Ngu, Janet M.C., O'Connor, Michael C., Odegard, Kirsten C., Oliveira, Ricardo, H. Olsen, Griffin, Orozco-Sevilla, Vicente, Ott, Harald C., Ouzounian, Maral, Padalino, Massimo, Pahwa, Siddharth V., Paul, Subroto, Palmeri, Nicholas O., Pandi, Dimosthenis, Patterson, G. Alexander, Perry, Yaron, Petrosyan, Mikael, Pettersson, Gosta B., Piana, Robert N., Piechura, Laura M., Pinto, Duane S., Polhemus, Emily, Pomar, Jose L., Pommerening, Matthew J., Porras, Diego, Preventza, Ourania, Pua, Bradley B., Puri, Varun, Qureshi, Saqib H., Quinonez, Luis G., Raman, Vignesh, Randhawa, Simran K., Ratcliffe, Mark, Reardon, Michael J., Reilly, John J., Rekhtman, Natasha, Revels, Jonathan W., Rhodin, Kristen E., Rice, David C., Rinewalt, Daniel E., Robinson, Kortney, Rocco, Gaetano, Rocco, Raffaele, Rokosh, Rae, Romano, Jennifer C., Roy, Nathalie, Rubens, Fraser D., Ruel, Marc, Ruiz-Solano, Elyan, Rusch, Valerie W., Saad, Marwan, Sabe, Ashraf A., Salvatore, Mary M., Sanders, Stephen P., Schaff, Hartzell V., Schaheen, Lara W., Schidlow, David, Schulz, Noah E., Scrimgeour, Laura A., Scully, Brandi Braud, Seder, Christopher W., Sellke, Frank W., Sengupta, Aditya, Sepesi, Boris, Shah, Adil Aijaz, Shahani, Rohit, Shamberger, Robert C., Shih, Emily, Shrager, Joseph B., Shudo, Yasuhiro, Sideris, Antonios, Singh, Steve K., Slaughter, Mark S., Smith, Craig R., Smith, Peter K., Smithers, Charles J., Sodha, Neel R., Solaro, R. John, Sotiropoulos, Georgios, Squiers, John J., Stephens, Elizabeth H., Stewart, Shelby J., Suri, Rakesh M., Suuronen, Erik J., Svensson, Lars G., Swanson, Scott J., Sweeney, Joseph C., Szeto, Wilson Y., Taggart, David, Takaya, Hiroki, Takeda, Koji, F. Tapias, Luis, Tapias, Leonidas, Taramasso, Maurizio, Thiagarajan, Ravi R., Thistlethwaite, Patricia A., Thourani, Vinod, Tompkins, Bryon A., Tong, Michael Z., Towe, Christopher, Triphuridet, Natthaya, Truesdell, Alexander G., Tuttle, Mark K., Tweddell, James Scott, Unai, Shinya, Urschel, Harold C., Valente, Anne Marie, Vallabhajosyula, MD, Prashanth, Vander, Pluym, Christina, Vargo, Patrick R., Vekstein, Andrew M., Vieira, Arthur, Vida, Vladimiro, Vijayakumar, Shilpa, Vlahakas, Gus, Voisine, Pierre, Wadowski, Benjamin, Wall, Matthew J., Wallace, Arthur W., Walsh, Garrett L., Wang, Vicky Y., Wang, Vivian, Wee, Jon O., Welsby, Ian, Wells, Dennis A., White, Abby, Wiener, Daniel C., Wierup, Per, Williams, Judson B., Winlaw, David S., Witten, James C., Wojnarski, Charles M., Wolska, Beata M., Woo, Y. Joseph, Wu, Fred M., Yang, Stephen C., Yasufuku, Kazuhiro, Yates, Tari-Ann, Zendejas, Benjamin, Zimetbaum, Peter J., and Zhang, Dongning

Published
2024
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13. Benefits and risks of tight glucose control in critically ill adults: a meta-analysis

Author

Wiener, Renda Soylemez, Wiener, Daniel C., and Larson, Robin J.

Subjects
Dextrose -- Health aspects, Dextrose -- Complications and side effects, Glucose -- Health aspects, Glucose -- Complications and side effects, Hypoglycemia -- Causes of
Abstract

A study attempts to evaluate the benefits and risks of tight glucose control as against normal care amongst critically ill adults. Findings suggest that in critically adult patients, tight glucose control is not associated with reduced mortality but is associated with an increased risk of hypoglycemia.

Published
2008

14. Controlled Apneic Tracheostomy in Patients with COVID-19

Author

Weiss, Kathleen D., Coppolino, Antonio, Wiener, Daniel C., McNamee, Ciaran, Riviello, Robert, Ng, Ju-Mei, Jaklitsch, Michael T., Marshall, Margaret B., and Rochefort, Matthew M.

Subjects
SARS-CoV-2, pandemic, coronavirus, COVID-19, tracheostomy, PEEP, positive end-expiratory pressure, mmHg, millimeters of mercury, ICU, intensive care unit, Article, SARS CoV-2, severe acute respiratory distress syndrome coronavirus 2, FiO2, fraction of inspired oxygen, OR, operating room, COVID-19, coronavirus disease, PPE, personal protective equipment
Abstract

Objective The objective of this study was to develop a team-based institutional infrastructure for navigating management of a novel disease, to determine a safe and effective approach for performing tracheostomies in patients with COVID-19 respiratory failure, and to review outcomes of patients and healthcare personnel following implementation of this approach. Methods An interdisciplinary Task Force was constructed to develop innovative strategies for management of a novel disease. A single-institution prospective non-randomized cohort study was then conducted on patients with COVID-19 respiratory failure who underwent tracheostomy using an induced bedside apneic technique at a tertiary care academic institution between April 27th, 2020, and June 30th, 2020. Results 28 patients underwent tracheostomy with induced apnea. The median lowest procedural oxygen saturation was 95%. The median number of ventilated days following tracheostomy was 11. There were 3 mortalities (11%) due to sepsis and multiorgan failure; of 25 surviving patients, 100% were successfully discharged from the hospital and 76% are decannulated, with a median time of 26 days from tracheostomy to decannulation (range 12 - 57). There was no symptomatic disease transmission to healthcare personnel on the COVID-19 Tracheostomy Team. Conclusions Patients with respiratory failure from COVID-19 disease may benefit from tracheostomy. This can be completed effectively and safely, without viral transmission to healthcare personnel. Performing tracheostomies earlier in the course of disease may expedite patient recovery and improve ICU resource utilization. Creation of a collaborative Task Force is an effective strategic approach for management of novel disease.

Published
2020

16. Mandatory Nodal Evaluation During Resection of Clinical T1a Non-Small Cell Lung Cancers.

Author

Dezube, Aaron R., Mazzola, Emanuele, Deeb, Ashley, Wiener, Daniel C., Marshall, M. Blair, Rochefort, Mathew W., and Jaklitsch, Michael T.

Abstract

Recommendations for intraoperative lymph node evaluation are uniform regardless of whether a primary tumor is clinical T1a or T2a according to TNM 8th edition for stage I non-small cell lung cancer (NSCLC). We quantified nodal disease risk in patients with T1a disease (≤1 cm). The National Cancer Database was queried for clinical T1a N0 M0 primary NSCLCs ≤1 cm undergoing lobectomy with mediastinal nodal evaluation from 2004-2014. Nodal disease risk was analyzed as a function of demographics and tumor characteristics. Among 2157 cases, 6.7% had occult nodal disease: 5.1% occult N1 and 1.6% N2. Adenocarcinoma (7.5%), large cell carcinoma (25%), and poor differentiation (11.8%) or undifferentiated/anaplastic (25.0%) had high rates of combined pN1 and N2 disease (P <.001). In univariable analysis, odds of pathologic N1, N2, or N1/N2 nodal disease with respect to N0 was greatest for large cell carcinoma (ref. adenocarcinoma odds ratio [OR] 4.31, 3.62, 4.12 respectively; all P <.05), and anaplastic grade (OR 10.71, 13.09, 11.55). Bronchoalveolar adenocarcinomas had the lowest odds (OR 0.41, 0.11, 0.32) and squamous cell carcinoma had lower odds for N2 (OR 0.29, all P <.05). In multivariable analysis only bronchoalveolar adenocarcinomas had lower odds of pathologic N2 and N1/N2 disease with respect to N0. Worsening grade remained significant for pathologic N1 and N1/N2 disease (both P <.05). A significant rate (6.7%) of occult nodal disease is present in primary NSCLCs ≤1 cm. Risk increases with certain histology and worsening grade. We recommend mandatory systematic hilar and mediastinal nodal evaluation for T1a NSCLC tumors for accurate staging and adjuvant therapy. [ABSTRACT FROM AUTHOR]

Published
2022
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22. Bronchopleural fistula due to cavitary pneumonia after SARS-CoV-2 infection treated with open thoracostomy.

Author

Belyayev, Leonid A, Foroushani, Sophia M, Wiener, Daniel C, Branch-Elliman, Westyn, Marshall, M Blair, and Khalil, Hassan A

Subjects
CORONAVIRUS diseases, BRONCHIAL fistula, SARS-CoV-2, FISTULA, THORACOSTOMY, COVID-19
Abstract

Severe coronavirus disease of 2019 (COVID-19) disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection causes substantial parenchymal damage in some patients. There is a paucity of literature describing the surgical management COVID-19 associated bronchopleural fistula after failure of medical therapy. We present the case of a 59-year-old woman with SARS-CoV-2 pneumonia, secondary bacterial pneumonia with bronchopleural fistula and radiographic and clinical evidence of disease refractory to medical therapy. After a course of culture-driven antimicrobial therapy and failure to improve following drainage with tube thoracostomy, she was treated successfully with Clagett open thoracostomy. After resolution of the bronchopleural fistula, the thoracostomy was closed and she was discharged home. In cases of severe COVID-19 complicated by bronchopleural fistula with parenchymal destruction, a tailored approach involving surgical management when indicated can lead to acceptable outcomes without significant morbidity. [ABSTRACT FROM AUTHOR]

Published
2022
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28. Cover Image, Volume 173A, Number 8, August 2017

Author

Wojcik, Monica H., primary, Carmichael, Nikkola, additional, Bieber, Frederick R., additional, Wiener, Daniel C., additional, Madan, Rachna, additional, Pober, Barbara R., additional, and Raby, Benjamin A., additional

Published
2017
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33. Benefits and risks of tight glucose control in critically ill adults: a meta-analysis.

Author

Soylemez Wiener R, Wiener DC, Larson RJ, Wiener, Renda Soylemez, Wiener, Daniel C, and Larson, Robin J

Abstract

Context: The American Diabetes Association and Surviving Sepsis Campaign recommend tight glucose control in critically ill patients based largely on 1 trial that shows decreased mortality in a surgical intensive care unit. Because similar studies report conflicting results and tight glucose control can cause dangerous hypoglycemia, the data underlying this recommendation should be critically evaluated.Objective: To evaluate benefits and risks of tight glucose control vs usual care in critically ill adult patients.Data Sources: MEDLINE (1950-2008), the Cochrane Library, clinical trial registries, reference lists, and abstracts from conferences from both the American Thoracic Society (2001-2008) and the Society of Critical Care Medicine (2004-2008).Study Selection: We searched for studies in any language in which adult intensive care patients were randomly assigned to tight vs usual glucose control. Of 1358 identified studies, 34 randomized trials (23 full publications, 9 abstracts, 2 unpublished studies) met inclusion criteria.Data Extraction and Analysis: Two reviewers independently extracted information using a prespecified protocol and evaluated methodological quality with a standardized scale. Study investigators were contacted for missing details. We used both random- and fixed-effects models to estimate relative risks (RRs).Results: Twenty-nine randomized controlled trials totaling 8432 patients contributed data for this meta-analysis. Hospital mortality did not differ between tight glucose control and usual care overall (21.6% vs 23.3%; RR, 0.93; 95% confidence interval [CI], 0.85-1.03). There was also no significant difference in mortality when stratified by glucose goal ([1] very tight: < or = 110 mg/dL; 23% vs 25.2%; RR, 0.90; 95% CI, 0.77-1.04; or [2] moderately tight: < 150 mg/dL; 17.3% vs 18.0%; RR, 0.99; 95% CI, 0.83-1.18) or intensive care unit setting ([1] surgical: 8.8% vs 10.8%; RR, 0.88; 95% CI, 0.63-1.22; [2] medical: 26.9% vs 29.7%; RR, 0.92; 95% CI, 0.82-1.04; or [3] medical-surgical: 26.1% vs 27.0%; RR, 0.95; 95% CI, 0.80-1.13). Tight glucose control was not associated with significantly decreased risk for new need for dialysis (11.2% vs 12.1%; RR, 0.96; 95% CI, 0.76-1.20), but was associated with significantly decreased risk of septicemia (10.9% vs 13.4%; RR, 0.76; 95% CI, 0.59-0.97), and significantly increased risk of hypoglycemia (glucose < or= 40 mg/dL; 13.7% vs 2.5%; RR, 5.13; 95% CI, 4.09-6.43).Conclusion: In critically ill adult patients, tight glucose control is not associated with significantly reduced hospital mortality but is associated with an increased risk of hypoglycemia. [ABSTRACT FROM AUTHOR]

Published
2008
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