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April 28, 2004

Supplemental Oxygen and Risk of Surgical Site Infection

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2004;291(16):1956. doi:10.1001/jama.291.16.1958-a

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.

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