Intensive Insulin Therapy And Glycemic Control To Alleviate Acute Lung Injury In Cardiac Surgery Under Cardiopulmonary Bypass

Aim and objectiveInsulin has been shown to have anti-inflammatory effects and also reducing the systemic inflammation during cardiopulmonary bypass (CPB), whereas hyperglycemia is known to increase the proinflammatory cytokines. In this study we aimed to assess the effect of Intensive Insulin Therapy(IIT) on cardiopulmonary bypass induced acute lung injury during cardiac surgeries.MethodsPatients (n=40) undergoing elective cardiac surgery with median sternotomy under cardiopulmonary bypass were selected and were randomly divided into 2 groups, group C and group T. Group C (n=20) was the control group of the study and did not receive any intensive insulin therapy. Group IIT (n=20) was the Intensive Insulin Therapy with patients receiving insulin therapy throughout the operation according to the ALGIP protocol. Bio markers: High Mobility Group Box-1, Tumor Necrosis Factor-alpha, Neutrophil Elastase, and Myeloperoxidase levels were measured at different timing point.ResultsBio markers levels were found to be lower in group IIT compared to group C. There was a significant decrease in the blood markers at two timing points(T2 and T3) in group IIT. High Mobility Group Box-1 had a biphasic increase in both groups but with values lower (p<0.05) in group IIT at 10 mins(T2) and 2 hours(T3) after unclamping of aorta. The same tendency was observed with Tumor Necrosis Factor-alpha, Neutrophil Elastase, and Myeloperoxidase levels at same timing points but with a monophasic increase.ConclusionOur results show that Intensive Insulin Therapy has a beneficial effect on the suppression of some of the inflammatory markers associated with acute lung injury during cardiopulmonary bypass.