title: Implementation of an intraoperative glycemic control protocol for cardiac surgery in a high-acuity academic medical center: an observational study.
abstract: OBJECTIVE
  To examine the effect on morbidity and mortality of an established intraoperative insulin protocol in cardiac surgical patients.
  
  
  METHODS
  Retrospective observational study.
  
  
  METHODS
  Single-center, 782 bed, metropolitan academic hospital.
  
  
  METHODS
  1,616 adult patients undergoing cardiac surgical procedures with cardiopulmonary bypass (CPB).
  
  
  METHODS
  An intraoperative, intravenous (IV) insulin protocol designed to maintain blood glucose values less than 150 mg/dL was implemented.
  
  
  METHODS
  Blood glucose was evaluated on entry to the operating room, every 30 minutes during CPB, and at least once after discontinuation of CPB. Blood glucose values were followed postoperatively, as dictated by institutional policy.
  
  
  RESULTS
  Intraoperative predictors of 30-day mortality using multivariate logistic regression included hyperglycemia on initiation of CPB (OR 1.0, P = 0.05). The strongest predictor of 30-day mortality was the development of postoperative renal failure requiring hemodialysis (OR 3.26, P = 0.001).
  
  
  CONCLUSIONS
  Implementation of an intraoperative IV insulin protocol, while associated with improved glycemic control, was not associated with improved outcomes. While improved glycemic control on initiating CPB was associated with decreased 30-day mortality, the effect was small. Implementation of our insulin protocol was highly associated with decreased renal failure postoperatively. Further prospective studies are warranted to better establish causality.
authors: Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA. Benjamin.Kohl@uphs.upenn.edu
authors: Benjamin A
authors: BA
authors: Kohl
authors: Mary S
authors: MS
authors: Hammond
authors: E Andrew
authors: EA
authors: Ochroch
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism; D006348:Cardiac Surgical Procedures / Q000401:mortality; D002315:Cardiopulmonary Bypass; D002985:Clinical Protocols; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use; D007430:Intraoperative Care / Q000379:methods*; D007676:Kidney Failure, Chronic / Q000097:blood / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin