Intensive perioperative glucose control does not improve outcomes of patients submitted to open-heart surgery: a randomized controlled trial.
BACKGROUND
The objective of this study was to investigate the relationship between different target levels of glucose and the clinical outcomes of patients undergoing cardiac surgery with cardiopulmonary bypass.


METHODS
We designed a prospective study in a university hospital where 109 consecutive patients were enrolled during a six-month period. All patients were scheduled for open-heart surgery requiring cardiopulmonary bypass. Patients were randomly allocated into two groups. One group consisted of 55 patients and had a target glucose level of 80-130 mg/dl, while the other contained 54 patients and had a target glucose level of 160-200 mg/dl. These parameters were controlled during surgery and for 36 hours after surgery in the intensive care unit. Primary outcomes were clinical outcomes, including time of mechanical ventilation, length of stay in the intensive care unit, infection, hypoglycemia, renal or neurological dysfunction, blood transfusion and length of stay in the hospital. The secondary outcome was a combined end-point (mortality at 30 days, infection or length of stay in the intensive care unit of more than 3 days). A p-value of <0.05 was considered significant.


RESULTS
The anthropometric and clinical characteristics of the patients from each group were similar, except for weight and body mass index. The mean glucose level during the protocol period was 126.69 mg/dl in the treated group and 168.21 mg/dl in the control group (p<0.0016). There were no differences between groups regarding clinical outcomes, including the duration of mechanical ventilation, length of stay in the intensive care unit, blood transfusion, postoperative infection, hypoglycemic event, neurological dysfunction or 30-day mortality (p>0.05).


CONCLUSIONS
In 109 patients undergoing cardiac surgery with cardiopulmonary bypass, both protocols of glycemic control in an intraoperative setting and in the intensive care unit were found to be safe, easily achieved and not to differentially affect clinical outcomes.
Chan
Raquel Pei Chen
RP
Department of Anesthesia and Surgical Intensive Care Unit, Instituto do Coração (InCor) , Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo.
Galas
Filomena Regina Barbosa Gomes
FR
Hajjar
Ludhmila Abrahão
LA
Bello
Carmen Narvaes
CN
Piccioni
Marilde Albuquerque
MA
Auler
José Otávio Costa
JO
D001786:Blood Glucose / Q000378:metabolism*; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D002318:Cardiovascular Diseases / Q000097:blood* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D019990:Perioperative Care; D011446:Prospective Studies; D016896:Treatment Outcome
D001786:Blood Glucose