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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.

Martin J. O'Neill, Jr, MD
Bloomington Hospital
Bloomington, Ind

1. Pryor KO, Fahey TJ 3rd, Lien CA, Goldstein PA. Surgical site infection and the routine use of perioperative hyperoxia in a general surgical population: a randomized controlled trial. JAMA. 2004;291:79-87. FREE FULL TEXT 2. Furnary A, Zerr K, Grunkemeier G, Starr A. Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures. Ann Thorac Surg. 1999;67:352-362. FREE FULL TEXT 3. Bandali K, Belanger M, Wittnich C. Does hyperoxia affect glucose regulation and transport in the newborn? J Thorac Cardiovasc Surg. 2003;126:1730-1735. FREE FULL TEXT

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

JAMA. 2004;291:1958.

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