Efficacy and safety of an insulin infusion protocol during and after cardiac surgery

Aim. - Perioperative tight blood glucose (BG) control using insulin therapy after major surgery is a difficult, time-consuming task that also raises some concerns over the risk or severe hypoglycaemia. The aim of the present prospective study wits to evaluate the efficacy and safety of all insulin therapy protocol in use at our institution. Methods. - A total of 230 consecutive patients (mean +/- SD age: 67 +/- 11 years diabetic patients: n = 62) undergoing cardiac surgery (coronary) artery bypass grating: n = 137; 20% off-pump) or intrathoracic aortic (n = 10) Surgery were included. BG control was managed according to all insulin therapy protocol, described by Goldberg et ill. (2004) 1111, ill use for 6 months in our intensive care unit. Insulin infusion rate and frequency adjusted according to: (I) the current BG value (2) the Previous BG value; and (3) the current insulin infusion rate. of BG monitoring were both ad E-Efficacy wits assessed by the percentage of time spent ill the target BG level (100-139 mg/dL) intraoperatively and during the first 2 postoperative days (POD). Results. -All patients received postoperative insulin therapy. Patients spent 57.3% and 69.7% of time within the BG target range oil POD I and I respectively. The percentage of time was significantly higher ill nondiabetics than in diabetics. Mean BG measurements per patient intraoperatively, oil POD I and oil POD 2 were 4 +/- 1, 10 +/- 2 and 7 +/- 2. respectively. No patient experienced any severe hypoglycaemic events (BG < 50 mg/dL). Conclusion. - This Study showed that a BG target of 100-139 mg/dL can be safely achieved with in insulin therapy protocol that can be routinely used in everyday clinical Practice. (C) 2009 Published by Elsevier Masson SAS.