title: Impact of the insulin and glucose content of the postoperative fluid on the outcome after pediatric cardiac surgery.
abstract: BACKGROUND
  The aim of this study was to investigate the role of the insulin and glucose content of the maintenance fluid in influencing the outcomes of pediatric patients undergoing heart surgery.
  
  
  METHODS
  A total of 2063 consecutive pediatric patients undergoing cardiac surgery were screened between 2003 and 2008. A dextrose and an insulin propensity-matched group were constructed. In the dextrose model, 5% and 10% dextrose maintenance infusions were compared below 20 kg of weight.
  
  
  RESULTS
  A total of 171 and 298 pairs of patients were matched in the insulin and glucose model, respectively. Mortality was lower in the insulin group (12.9% vs. 7%, p = 0.049). The insulin group had longer intensive care unit (ICU) stay [days, 10.9 (5.8-18.4) vs. 13.7 (8.2-21), p = 0.003], hospital stay [days, 19.8 (13.6-26.6) vs. 22.7 (17.6-29.7), p < 0.01], duration of mechanical ventilation [hours, 67 (19-140) vs. 107 (45-176), p = 0.006], and the incidence of severe infections (18.1% vs. 28.7%, p = 0.01) and dialysis (11.7% vs. 24%, p = 0.001) was higher. In the dextrose model, the incidence of pulmonary complications (13.09% vs. 22.5%, p < 0.01), low cardiac output (17.11% vs. 30.9%, p < 0.01), and severe infections (10.07% vs. 20.5%, p < 0.01) was higher, and the duration of the hospital stay [days, 16.4 (13.1-21.6) vs. 18.1 (13.8-24.6), p < 0.01] was longer in the 10% dextrose group.
  
  
  CONCLUSIONS
  Insulin treatment appeared to decrease mortality, and lower glucose content was associated with lower occurrence of adverse events.
authors.forename: Dániel J
authors.initials: DJ
authors.lastname: Lex
authors.forename: Péter
authors.initials: P
authors.lastname: Szántó
authors.forename: Tamás
authors.initials: T
authors.lastname: Breuer
authors.forename: Roland
authors.initials: R
authors.lastname: Tóth
authors.forename: Mihály
authors.initials: M
authors.lastname: Gergely
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Prodán
authors.forename: Erzsébet
authors.initials: E
authors.lastname: Sápi
authors.forename: András
authors.initials: A
authors.lastname: Szatmári
authors.forename: Tamás
authors.initials: T
authors.lastname: Szántó
authors.forename: János
authors.initials: J
authors.lastname: Gál
authors.forename: Andrea
authors.initials: A
authors.lastname: Székely
keywords: cardiac surgery; children; critical care; dextrose; glucose; heart surgery; insulin; maintenance infusion; pediatrics