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Glucose management during cardiopulmonary bypass: cardiovascular and neurologic implications.

Metz and Keats (1) report in the present issue on the relationship between glucose-containing priming solutions in the cardiopulmonary bypass (CPB) circuit and perioperative cardiac and neurologic function. Their conclusions are twofold: first, glucose solutions in the CPB circuit reduce intraoperative fluid requirements and improve perioperative fluid balance; and, second, glucose does not increase postoperative neurologic injury. When reduced to its essence, the study by Metz and Keats had a single positive finding: glucose-treated subjects had a more favorable perioperative fluid balance. The use of glucose was associated with increased urine output, but it did not alter inotrope use, diuretic requirement, or hospital course. The greatest difference in fluid requirement occurred during the CPB period: glucose-treated subjects received one-eighth the amount of crystalloid given to non-glucose-treated patients (144 * 270 vs 1147 * 1149 mL; mean ? SD; P < 0.001). The decision to give fluid during CPB was based on the status of the CPB-reservoir volume, and flexibility was permitted ”depending on (the) stage of operation.” The process was not blinded. The second conclusion of the study by Metz and Keats was that glucose administration during CPB and coronary artery bypass grafting (CABG) does not adversely affect postoperative neurologic function. This conclusion, based on data from their study and from their interpretation of the related literature, deserves comment. The study by Metz and Keats evaluated 107 patients undergoing CABG. They reported only two