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Published in: BMC Pulmonary Medicine 1/2014

Open Access 01-12-2014 | Research article

Intravenous insulin therapy during lung resection does not affect lung function or surfactant proteins

Authors: Zdenek Ručka, Irena Koutná, Lenka Tesařová, Michaela Potěšilová, Stanislav Stejskal, Pavel Šimara, Petr Vaňhara, Jan Doležel, Vaclav Zvoníček, Oldřich Coufal, Ivan Čapov

Published in: BMC Pulmonary Medicine | Issue 1/2014

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Abstract

Background

The surgical resection of lung disrupts glucose homeostasis and causes hyperglycemia, as in any other major surgery or critical illness. We performed a prospective study where we carefully lowered hyperglycemia by insulin administration during the surgery, and for the first time we monitored immediate insulin effects on lung physiology and gene transcription.

Methods

The levels of blood gases (pH, pCO2, pO2, HCO3-, HCO3- std, base excess, FiO2, and pO2/FiO2) were measured at the beginning of surgery, at the end of surgery, and two hours after. Samples of healthy lung tissue surrounding the tumour were obtained during the surgery, anonymized and sent for subsequent blinded qPCR analysis (mRNA levels of surfactant proteins A1, A2, B, C and D were measured). This study was done on a cohort of 64 patients who underwent lung resection. Patients were randomly divided, and half of them received insulin treatment during the surgery.

Results

We demonstrated for the first time that insulin administered intravenously during lung resection does not affect levels of blood gases. Furthermore, it does not induce immediate changes in the expression of surfactant proteins.

Conclusion

According to our observations, short insulin treatment applied intravenously during resection does not affect the quality of breathing.
Appendix
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Literature
1.
go back to reference Bagshaw SM, Egi M, George C, Bellomo R, Committee ANZICSDM: Early blood glucose control and mortality in critically ill patients in Australia. Crit Care Med. 2009, 37 (2): 463-470. 10.1097/CCM.0b013e318194b097.CrossRefPubMed Bagshaw SM, Egi M, George C, Bellomo R, Committee ANZICSDM: Early blood glucose control and mortality in critically ill patients in Australia. Crit Care Med. 2009, 37 (2): 463-470. 10.1097/CCM.0b013e318194b097.CrossRefPubMed
2.
go back to reference Kwon S, Thompson R, Dellinger P, Yanez D, Farrohki E, Flum D: Importance of perioperative glycemic control in general surgery: a report from the surgical care and outcomes assessment program. Ann Surg. 2013, 257 (1): 8-14. 10.1097/SLA.0b013e31827b6bbc.CrossRefPubMedPubMedCentral Kwon S, Thompson R, Dellinger P, Yanez D, Farrohki E, Flum D: Importance of perioperative glycemic control in general surgery: a report from the surgical care and outcomes assessment program. Ann Surg. 2013, 257 (1): 8-14. 10.1097/SLA.0b013e31827b6bbc.CrossRefPubMedPubMedCentral
3.
go back to reference Rucka Z, Vanhara P, Koutna I, Tesarova L, Potesilova M, Stejskal S, Simara P, Dolezel J, Zvonicek V, Coufal O, Capov I: Differential effects of insulin and dexamethasone on pulmonary surfactant-associated genes and proteins in A549 and H441 cells and lung tissue. Int J Mol Med. 2013, 32 (1): 211-218.PubMed Rucka Z, Vanhara P, Koutna I, Tesarova L, Potesilova M, Stejskal S, Simara P, Dolezel J, Zvonicek V, Coufal O, Capov I: Differential effects of insulin and dexamethasone on pulmonary surfactant-associated genes and proteins in A549 and H441 cells and lung tissue. Int J Mol Med. 2013, 32 (1): 211-218.PubMed
4.
go back to reference Dekowski S, Snyder J: Insulin regulation of messenger ribonucleic acid for the surfactant-associated proteins in human fetal lung in vitro. Endocrinology. 1992, 131 (2): 669-676.PubMed Dekowski S, Snyder J: Insulin regulation of messenger ribonucleic acid for the surfactant-associated proteins in human fetal lung in vitro. Endocrinology. 1992, 131 (2): 669-676.PubMed
5.
go back to reference Kumar A, Snyder J: Differential regulation of SP-A1 and SP-A2 genes by cAMP, glucocorticoids, and insulin. Am J Physiol. 1998, 274 (2 Pt 1): L177-L185.PubMed Kumar A, Snyder J: Differential regulation of SP-A1 and SP-A2 genes by cAMP, glucocorticoids, and insulin. Am J Physiol. 1998, 274 (2 Pt 1): L177-L185.PubMed
6.
go back to reference Miakotina OL, Goss KL, Snyder JM: Insulin utilizes the PI 3-kinase pathway to inhibit SP-A gene expression in lung epithelial cells. Respir Res. 2002, 3: 27-10.1186/rr191.CrossRefPubMedPubMedCentral Miakotina OL, Goss KL, Snyder JM: Insulin utilizes the PI 3-kinase pathway to inhibit SP-A gene expression in lung epithelial cells. Respir Res. 2002, 3: 27-10.1186/rr191.CrossRefPubMedPubMedCentral
7.
go back to reference Denham M, Conley BJ, Olsson F, Gulluyan L, Cole TJ, Mollard R: A murine respiratory-inducing niche displays variable efficiency across human and mouse embryonic stem cell species. Am J Physiol Lung Cell Mol Physiol. 2007, 292 (5): L1241-L1247. 10.1152/ajplung.00440.2006.CrossRefPubMed Denham M, Conley BJ, Olsson F, Gulluyan L, Cole TJ, Mollard R: A murine respiratory-inducing niche displays variable efficiency across human and mouse embryonic stem cell species. Am J Physiol Lung Cell Mol Physiol. 2007, 292 (5): L1241-L1247. 10.1152/ajplung.00440.2006.CrossRefPubMed
8.
go back to reference van Iwaarden F, Welmers B, Verhoef J, Haagsman H, van Golde L: Pulmonary surfactant protein A enhances the host-defense mechanism of rat alveolar macrophages. Am J Respir Cell Mol Biol. 1990, 2 (1): 91-98. 10.1165/ajrcmb/2.1.91.CrossRefPubMed van Iwaarden F, Welmers B, Verhoef J, Haagsman H, van Golde L: Pulmonary surfactant protein A enhances the host-defense mechanism of rat alveolar macrophages. Am J Respir Cell Mol Biol. 1990, 2 (1): 91-98. 10.1165/ajrcmb/2.1.91.CrossRefPubMed
9.
go back to reference Finfer S, Chittock D, Su S, Blair D, Foster D, Dhingra V, Bellomo R, Cook D, Dodek P, Henderson W, Hébert P, Heritier S, Heyland D, McArthur C, McDonald E, Mitchell I, Myburgh J, Norton R, Potter J, Robinson B, Ronco J: Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009, 360 (13): 1283-1297.CrossRefPubMed Finfer S, Chittock D, Su S, Blair D, Foster D, Dhingra V, Bellomo R, Cook D, Dodek P, Henderson W, Hébert P, Heritier S, Heyland D, McArthur C, McDonald E, Mitchell I, Myburgh J, Norton R, Potter J, Robinson B, Ronco J: Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009, 360 (13): 1283-1297.CrossRefPubMed
10.
go back to reference Mowery NT, Gunter OL, Kauffmann RM, Diaz JJ, Collier BC, May AK: Duration of time on intensive insulin therapy predicts severe hypoglycemia in the surgically critically ill population. World J Surg. 2012, 36 (2): 270-277. 10.1007/s00268-011-1356-4.CrossRefPubMed Mowery NT, Gunter OL, Kauffmann RM, Diaz JJ, Collier BC, May AK: Duration of time on intensive insulin therapy predicts severe hypoglycemia in the surgically critically ill population. World J Surg. 2012, 36 (2): 270-277. 10.1007/s00268-011-1356-4.CrossRefPubMed
11.
go back to reference Mowery NT, Guillamondegui OD, Gunter OL, Diaz JJ, Collier BR, Dossett LA, Dortch MJ, May AK: Severe hypoglycemia while on intensive insulin therapy is not an independent predictor of death after trauma. J Trauma. 2010, 68 (2): 342-347. 10.1097/TA.0b013e3181c825f2.CrossRefPubMed Mowery NT, Guillamondegui OD, Gunter OL, Diaz JJ, Collier BR, Dossett LA, Dortch MJ, May AK: Severe hypoglycemia while on intensive insulin therapy is not an independent predictor of death after trauma. J Trauma. 2010, 68 (2): 342-347. 10.1097/TA.0b013e3181c825f2.CrossRefPubMed
12.
go back to reference Krinsley J, Schultz MJ, Spronk PE, van Braam Houckgeest F, van der Sluijs JP, Mélot C, Preiser JC, Preiser JC: Mild hypoglycemia is strongly associated with increased intensive care unit length of stay. CMAJ. 2011, 1: 49- Krinsley J, Schultz MJ, Spronk PE, van Braam Houckgeest F, van der Sluijs JP, Mélot C, Preiser JC, Preiser JC: Mild hypoglycemia is strongly associated with increased intensive care unit length of stay. CMAJ. 2011, 1: 49-
13.
go back to reference den Berghe GV: Intensive insulin therapy in the ICU-reconciling the evidence. Nat Rev Endocrinol. 2012, 8 (6): 374-378. den Berghe GV: Intensive insulin therapy in the ICU-reconciling the evidence. Nat Rev Endocrinol. 2012, 8 (6): 374-378.
14.
go back to reference Preiser JC, Devos P, Ruiz-Santana S, Mélot C, Annane D, Groeneveld J, Iapichino G, Leverve X, Nitenberg G, Singer P, Wernerman J, Joannidis M, Stecher A, Chioléro R: A prospective randomised multi-centre controlled trial on tight glucose control by intensive insulin therapy in adult intensive care units: the Glucontrol study. Intensive Care Med. 2009, 35 (10): 1738-1748. 10.1007/s00134-009-1585-2.CrossRefPubMed Preiser JC, Devos P, Ruiz-Santana S, Mélot C, Annane D, Groeneveld J, Iapichino G, Leverve X, Nitenberg G, Singer P, Wernerman J, Joannidis M, Stecher A, Chioléro R: A prospective randomised multi-centre controlled trial on tight glucose control by intensive insulin therapy in adult intensive care units: the Glucontrol study. Intensive Care Med. 2009, 35 (10): 1738-1748. 10.1007/s00134-009-1585-2.CrossRefPubMed
15.
go back to reference Griesdale DE, de Souza RJ, van Dam RM, Heyland DK, Cook DJ, Malhotra A, Dhaliwal R, Henderson WR, Chittock DR, Finfer S, Talmor D: Intensive insulin therapy and mortality among critically ill patients: a meta-analysis including NICE-SUGAR study data. CMAJ. 2009, 180 (8): 821-827. 10.1503/cmaj.090206.CrossRefPubMed Griesdale DE, de Souza RJ, van Dam RM, Heyland DK, Cook DJ, Malhotra A, Dhaliwal R, Henderson WR, Chittock DR, Finfer S, Talmor D: Intensive insulin therapy and mortality among critically ill patients: a meta-analysis including NICE-SUGAR study data. CMAJ. 2009, 180 (8): 821-827. 10.1503/cmaj.090206.CrossRefPubMed
16.
go back to reference Astrup P, Jorgensen K, Andersen OS, ENGEL K: The acid-base metabolism. A new approach Lancet. 1960, 1 (7133): 1035-1039.PubMed Astrup P, Jorgensen K, Andersen OS, ENGEL K: The acid-base metabolism. A new approach Lancet. 1960, 1 (7133): 1035-1039.PubMed
17.
go back to reference BAER DM: Acid-base disorders. The clinical use of the astrup method of determining ph, Pco2 and base excess. Calif Med. 1964, 101: 439-444.PubMedPubMedCentral BAER DM: Acid-base disorders. The clinical use of the astrup method of determining ph, Pco2 and base excess. Calif Med. 1964, 101: 439-444.PubMedPubMedCentral
18.
go back to reference JORGENSEN K, ASTRUP P: Standard bicarbonate, its clinical significance, and a new method for its determination. Scand J Clin Lab Invest. 1957, 9 (2): 122-132. 10.3109/00365515709101210.CrossRefPubMed JORGENSEN K, ASTRUP P: Standard bicarbonate, its clinical significance, and a new method for its determination. Scand J Clin Lab Invest. 1957, 9 (2): 122-132. 10.3109/00365515709101210.CrossRefPubMed
19.
go back to reference Van den Berghe G, Schetz M, Vlasselaers D, Hermans G, Wilmer A, Bouillon R, Mesotten D: Clinical review: Intensive insulin therapy in critically ill patients: NICE-SUGAR or Leuven blood glucose target?. J Clin Endocrinol Metab. 2009, 94 (9): 3163-3170. 10.1210/jc.2009-0663.CrossRefPubMed Van den Berghe G, Schetz M, Vlasselaers D, Hermans G, Wilmer A, Bouillon R, Mesotten D: Clinical review: Intensive insulin therapy in critically ill patients: NICE-SUGAR or Leuven blood glucose target?. J Clin Endocrinol Metab. 2009, 94 (9): 3163-3170. 10.1210/jc.2009-0663.CrossRefPubMed
20.
go back to reference Fleige S, Pfaffl MW: RNA integrity and the effect on the real-time qRT-PCR performance. Mol Aspects Med. 2006, 27 (2–3): 126-139.CrossRefPubMed Fleige S, Pfaffl MW: RNA integrity and the effect on the real-time qRT-PCR performance. Mol Aspects Med. 2006, 27 (2–3): 126-139.CrossRefPubMed
21.
go back to reference Liu D, Chen S, Liu H: Choice of endogenous control for gene expression in nonsmall cell lung cancer. Eur Respir J. 2005, 26 (6): 1002-1008. 10.1183/09031936.05.00050205.CrossRefPubMed Liu D, Chen S, Liu H: Choice of endogenous control for gene expression in nonsmall cell lung cancer. Eur Respir J. 2005, 26 (6): 1002-1008. 10.1183/09031936.05.00050205.CrossRefPubMed
22.
23.
go back to reference Glasby MA, Huang CLH: Applied Physiology for Surgery and Critical Care. 1995, Oxford: Butterworth-Heinemann Glasby MA, Huang CLH: Applied Physiology for Surgery and Critical Care. 1995, Oxford: Butterworth-Heinemann
24.
go back to reference Schlichtig R, Grogono AW, Severinghaus JW: Human PaCO2 and standard base excess compensation for acid-base imbalance. Crit Care Med. 1998, 26 (7): 1173-1179. 10.1097/00003246-199807000-00015.CrossRefPubMed Schlichtig R, Grogono AW, Severinghaus JW: Human PaCO2 and standard base excess compensation for acid-base imbalance. Crit Care Med. 1998, 26 (7): 1173-1179. 10.1097/00003246-199807000-00015.CrossRefPubMed
25.
go back to reference Gibson RB: Effects Of Insulin And Glucose On Acid-Base Balance In Surgical Diabetic Patients. JAMA. 1926, 86 (16): 1209-CrossRef Gibson RB: Effects Of Insulin And Glucose On Acid-Base Balance In Surgical Diabetic Patients. JAMA. 1926, 86 (16): 1209-CrossRef
26.
go back to reference Rymarz E, Mosiewicz J, Hanzlik J: The influence of glucose-insulin-kalium mixture (GIK) on the selected parameters of acid-base balance in acute myocardial infarction. Ann Univ Mariae Curie Sklodowska Med. 2001, 56: 1-6.PubMed Rymarz E, Mosiewicz J, Hanzlik J: The influence of glucose-insulin-kalium mixture (GIK) on the selected parameters of acid-base balance in acute myocardial infarction. Ann Univ Mariae Curie Sklodowska Med. 2001, 56: 1-6.PubMed
27.
go back to reference Miakotina OL, Dekowski SA, Snyder JM: Insulin inhibits surfactant protein A and B gene expression in the H441 cell line. Biochim Biophys Acta. 1998, 1442 (1): 60-70. 10.1016/S0167-4781(98)00121-3.CrossRefPubMed Miakotina OL, Dekowski SA, Snyder JM: Insulin inhibits surfactant protein A and B gene expression in the H441 cell line. Biochim Biophys Acta. 1998, 1442 (1): 60-70. 10.1016/S0167-4781(98)00121-3.CrossRefPubMed
28.
go back to reference Orgeig S, Morrison JL, Daniels CB: Prenatal development of the pulmonary surfactant system and the influence of hypoxia. Respir Physiol Neurobiol. 2011, 178 (1): 129-145. 10.1016/j.resp.2011.05.015.CrossRefPubMed Orgeig S, Morrison JL, Daniels CB: Prenatal development of the pulmonary surfactant system and the influence of hypoxia. Respir Physiol Neurobiol. 2011, 178 (1): 129-145. 10.1016/j.resp.2011.05.015.CrossRefPubMed
Metadata
Title
Intravenous insulin therapy during lung resection does not affect lung function or surfactant proteins
Authors
Zdenek Ručka
Irena Koutná
Lenka Tesařová
Michaela Potěšilová
Stanislav Stejskal
Pavel Šimara
Petr Vaňhara
Jan Doležel
Vaclav Zvoníček
Oldřich Coufal
Ivan Čapov
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Pulmonary Medicine / Issue 1/2014
Electronic ISSN: 1471-2466
DOI
https://doi.org/10.1186/1471-2466-14-155

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