Improving glycemic control in the cardiothoracic intensive care unit: clinical experience in two hospital settings.
OBJECTIVE
Recent studies suggest that strict perioperative glycemic control improves clinical outcomes after cardiothoracic surgery. However, optimal methods and targets for controlling blood glucose (BG) levels in this setting have not been established. Currently published intensive insulin infusion protocols (IIPs) have important practical limitations, which may affect their utility. In this article, the authors present their experience with a safe, effective, nurse-driven IIP, which was implemented simultaneously in 2 cardiothoracic intensive care units (CTICUs).


METHODS
Prospective cohort study.


METHODS
Tertiary referral hospital and community teaching hospital.


METHODS
CTICU patients.


METHODS
A standardized, intensive IIP was used for all patients admitted to both CTICUs. Hourly BG levels, relevant baseline variables, and clinical interventions were collected prospectively from the active hospital chart and CTICU nursing records.


RESULTS
The IIP was used 137 times in 118 patients. The median time required to reach target BG levels (100-139 mg/dL) was 5 hours. Once BG levels decreased below 140 mg/dL, 58% of 2,242 subsequent hourly BG values fell within the narrow target range, 73% within a "clinically desirable" range of 80 to 139 mg/dL, and 94% within a "clinically acceptable" range of 80 to 199 mg/dL. Only 5 (0.2%) BG values were less than 60 mg/dL, with no associated adverse clinical events.


CONCLUSIONS
The IIP safely and effectively improved glycemic control in 2 CTICUs, with minimal hypoglycemia. Based on prior studies showing the benefits of strict glycemic control, the implementation of this IIP should help to reduce morbidity and mortality in CTICU patients.
Goldberg
Philip A
PA
Department of Internal Medicine, Section of Endocrinology, Yale New Haven Hospital, Yale University School of Medicine, New Haven, CT 06520-8020, USA.
Sakharova
Olga V
OV
Barrett
Peter W
PW
Falko
Lillian N
LN
Roussel
Maureen G
MG
Bak
Leigh
L
Blake-Holmes
Dawn
D
Marieb
Norman J
NJ
Inzucchi
Silvio E
SE
D000368:Aged; D001786:Blood Glucose / Q000187:drug effects; D006348:Cardiac Surgical Procedures / Q000379:methods*; D015331:Cohort Studies; D016903:Drug Monitoring / Q000451:nursing*; D005260:Female; D006764:Hospitals, Community; D006784:Hospitals, Teaching; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000188:drug therapy* / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000097:blood / Q000627:therapeutic use; D007262:Infusions, Intravenous / Q000379:methods; D007328:Insulin / Q000009:adverse effects / Q000097:blood / Q000627:therapeutic use*; D007332:Insulin Infusion Systems / Q000706:statistics & numerical data; D007362:Intensive Care Units; D008297:Male; D011183:Postoperative Complications / Q000097:blood / Q000517:prevention & control; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin