Endocrine and metabolic management in the cardiothoracic ICU

In this chapter, we review several important endocrine disorders frequently encountered in patients undergoing cardiothoracic surgery. Hyperglycemia, common in patients with and without diabetes mellitus (DM) in the perioperative period, has been linked to poor outcomes. Use of an intravenous insulin infusion early in the postoperative course, followed by transition to subcutaneous insulin, with maintenance of moderate glycemic targets (100-180 mg/dL) is currently the standard of care. Oral intake should be encouraged in the postoperative period, but if not possible, nutrition support with enteral nutrition should be considered. Critical illness related corticosteroid insufficiency (CIRCI) should be suspected in critically ill patients with refractory hypotension requiring vasopressors, especially in the setting of septic shock. Although diagnositic criteria are controversial, if suspected, empiric treatment with corticosteroids should be initiated. Nonthyroidal illness syndrome (NTIS) is common in critically ill patients and thyroid function tests should be interpreted with caution in this population.