High-dose glucose-insulin-potassium after cardiac surgery: a retrospective analysis of clinical safety issues.
BACKGROUND
Metabolic treatment with insulin or glucose-insulin-potassium (GIK) has received attention in association with myocardial infarction, cardiac surgery and critical care. As a result of insulin resistance during neuroendocrine stress, doses of insulin up to 1 IU kg-1 b.w.*h are required to achieve maximal metabolic effects after cardiac surgery. The clinical experience with regard to safety issues of such a high-dose GIK regime in critically ill patients after cardiac surgery is reported.


METHODS
Retrospective, observational study involving all patients treated with high-dose GIK after cardiac surgery during one year in a cardiovascular center at a University Hospital.


RESULTS
Eighty-nine patients out of 854 adult patients undergoing cardiac surgery were treated with high-dose GIK. Mean age was 69 +/- 1 years, Higgins score 5.3 +/- 0.3. Preoperatively 31.4% had left ventricular function EF< or =0.35 and 32.5% had sustained a myocardial infarct during surgery. Mortality was 5.6% and the average ICU stay was 3.7 +/- 0.5 days. The main indication for GIK was intraoperative heart failure (69.7%). The average glucose infusion rate during the first 6 h was 4.22 +/- 0.15 and 4.91 +/- 0.14 mg kg-1 b.w.*min, respectively, in diabetic and non-diabetic patients (P = 0.023). Blood glucose and s-potassium control was acceptable.


CONCLUSIONS
The high-dose GIK regime allowed substantial amounts of glucose to be infused both in diabetic and critically ill patients with maintenance of acceptable blood glucose control. Provided careful monitoring, this regime can be safely used in clinical practice and deserves further evaluation for treatment of critically ill patients following cardiac surgery.
Szabó
Z
Z
Departments of Cardiothoracic Anesthesia and Intensive Care and Cardiothoracic Surgery, Linköping Heart Center, University Hospital, Linköping, Sweden. Zoltan.Szabo@lio.se
Håkanson
E
E
Maros
T
T
Svedjeholm
R
R
D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D002303:Cardiac Output, Low / Q000209:etiology / Q000628:therapy*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D016638:Critical Illness; D003924:Diabetes Mellitus, Type 2 / Q000097:blood; D005260:Female; D005947:Glucose / Q000008:administration & dosage* / Q000009:adverse effects; D006439:Hemodynamics; D006801:Humans; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D017202:Myocardial Ischemia / Q000209:etiology / Q000628:therapy*; D011183:Postoperative Complications / Q000628:therapy*; D011188:Potassium / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood; D012189:Retrospective Studies; D014655:Vascular Resistance / Q000187:drug effects
D001786:Blood Glucose; D007328:Insulin; C030396:glucose-insulin-potassium cardioplegic solution; D005947:Glucose; D011188:Potassium