Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
To the Editor: Dr Pryor and colleagues1 did not evaluate the potential effect of hyperglycemia
on rates of infection. It has been reported that controlling levels of blood
glucose in the perioperative period is important in preventing deep sternal
wound infections in patients with diabetes who undergo cardiac surgery.2 Unmeasured hyperglycemia may thus have been a factor
in these unexpected results. Maintenance of blood glucose levels below 200
mg/dL (11.1 mmol/L) with a continuous infusion of insulin was an important
determinant of avoiding a postoperative infection in cardiac surgical patients.2 Furthermore, animal studies have found that hyperoxia
can lead to sustained hyperglycemia.3 Thus,
I believe it would have been worthwhile to evaluate the perioperative levels
of blood glucose to determine if hyperglycemia existed; and, if so, it may
explain why hyperoxia was of no benefit and might possibly be related to the
increased rate of infection in this study.
O'Neill, Jr MJ. Supplemental Oxygen and Risk of Surgical Site Infection. JAMA. 2004;291(16):1956. doi:10.1001/jama.291.16.1958-a