Happy 53rd Birthday GIK: Insulin, Cake, and Presents.
Happy 53rd Birthday GIK: Insulin, Cake, and Presents.
复制标题
GIK 53 岁生日快乐：胰岛素、蛋糕和礼物。
DOI：
10.1097/aln.0000000000000724
复制
发表时间：
2015
期刊：
影响因子：
8.8
通讯作者：
Gross,EricR
中科院分区：
文献类型：
--
作者：
Cole,SheelaPai;Gross,EricR
Nearly 53 years ago, the use of glucose, insulin and potassium (GIK) infusions were introduced into medical practice to reduce myocardial injury during a heart attack1 and subsequently applied to cardiac surgery. What particular component (s) of GIK, the glucose, insulin and/or potassium, provide myocardial benefits for cardiac surgery continues to be studied and questioned. In this month’s Anesthesiology, Duncan and colleagues determined patients subjected to a hyperinsulinemic, normoglycemic clamp had no outcome benefit when compared to patients undergoing standard insulin treatment for aortic valve replacement2.For the study, Duncan and colleagues used speckle tracking echocardiography (STE) to determine there were no differences in myocardial function between the groups (Figure for more detailed explanation). As shown by the authors, STE provides valuable information including myocardial strain and strain rate. However, to apply this technique for routine clinical practice, a number of challenges need to be addressed. Currently, STE remains an offline “after the fact” modality in most centers. The software is not standardized between machines and the data sampling software used is proprietary. This continues to be an ongoing discussion among industry and echocardiography governing societies3. Further, STE remains vulnerable to high signal noise, such as artifacts secondary to aortic valve calcium deposits. This perhaps explains why some of the images were discarded for interpretation in this study. Eventually, these limitations will be solved by ongoing improvements in machines, better practitioner understanding, and incorporation of STE into intraoperative work-flow to make this technique more useful within the operating room.
