title: Computer-guided normal-low versus normal-high potassium control after cardiac surgery: No impact on atrial fibrillation or atrial flutter.
abstract: BACKGROUND
  This study was designed to determine the effect of 2 different potassium regulation strategies with different targets (within the reference range) on atrial fibrillation (AF) or atrial flutter (AFL) in a cohort of intensive care unit patients after cardiac surgery.
  
  
  METHODS
  The GRIP-COMPASS study was a prospective double-blinded interventional study in 910 patients after cardiac surgery (coronary artery bypass grafting and/or valvular surgery). Patients were assigned to either the normal-low potassium target (nLP group, 4.0 mmol/L) or the normal-high potassium target (nHP group, 4.5 mmol/L) in alternating blocks of 50 patients. Potassium levels were regulated using a validated computer-assisted potassium replacement protocol (GRIP-II). The primary end point was the incidence of AF/AFL on a 12-lead electrocardiogram during the first postoperative week.
  
  
  RESULTS
  Of the 910 patients, 447 were assigned to the nLP group; and 463, to the nHP group, with no baseline differences between the 2 groups. The mean daily administered dose of potassium was 30 ± 23 mmol (nLP) versus 52 ± 27 mmol (nHP) (P < .001), which resulted in mean intensive care unit potassium concentration of 4.22 ± 0.36 mmol/L and 4.33 ± 0.34 mmol/L, respectively (P < .001). The incidence of AF/AFL after cardiac surgery did not differ: 38% in the nLP group and 41% in the nHP group. Also in several subgroups (eg, patients not known with prior AF/AFL or with valve surgery), there were no differences.
  
  
  CONCLUSIONS
  There were no differences in incidence of AF/AFL with 2 potassium regulation strategies with different potassium targets and different amounts of potassium administered in patients after cardiac surgery.
authors: Department of Anesthesiology of the University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. Electronic address: m.hoekstra01@umcg.nl.
authors: Miriam
authors: M
authors: Hoekstra
authors: Department of Critical Care of the University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. Electronic address: l.hessels@umcg.nl.
authors: Lara
authors: L
authors: Hessels
authors: Department of Cardiology of the University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. Electronic address: m.rienstra@umcg.nl.
authors: Michiel
authors: M
authors: Rienstra
authors: Department of Anesthesiology of the University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. Electronic address: l.yeh@umcg.nl.
authors: Lu
authors: L
authors: Yeh
authors: Department of Critical Care of the University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. Electronic address: a.oudelansink@umcg.nl.
authors: Annemieke Oude
authors: AO
authors: Lansink
authors: Department of Critical Care of the University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. Electronic address: m.vogelzang@umcg.nl.
authors: Mathijs
authors: M
authors: Vogelzang
authors: Department of Critical Care of the University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. Electronic address: i.c.c.van.der.horst@umcg.nl.
authors: Iwan C C
authors: IC
authors: van der Horst
authors: Department of Anesthesiology of the University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Critical Care of the University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. Electronic address: j.m.a.a.van.der.maaten@umcg.nl.
authors: Joost M A A
authors: JM
authors: van der Maaten
authors: Department of Cardiothoracic Surgery of the University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. Electronic address: m.mariani@umcg.nl.
authors: Massimo A
authors: MA
authors: Mariani
authors: Department of Critical Care of the University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. Electronic address: a.m.g.a.de.smet@umcg.nl.
authors: Anne Marie G A
authors: AM
authors: de Smet
authors: Department of Anesthesiology of the University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. Electronic address: m.m.r.f.struys@umcg.nl.
authors: Michel M R F
authors: MM
authors: Struys
authors: Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands. Electronic address: f.zijlstra1@erasmc.nl.
authors: Felix
authors: F
authors: Zijlstra
authors: Department of Critical Care of the University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. Electronic address: m.w.n.nijsten@umcg.nl.
authors: Maarten W
authors: MW
authors: Nijsten
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000517:prevention & control*; D001282:Atrial Flutter / Q000453:epidemiology / Q000517:prevention & control*; D006348:Cardiac Surgical Procedures; D004311:Double-Blind Method; D016903:Drug Monitoring / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000097:blood / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D011182:Postoperative Care / Q000379:methods*; D011188:Potassium / Q000008:administration & dosage* / Q000493:pharmacokinetics; D011446:Prospective Studies
chemical_list: D011188:Potassium