title: Computerised insulin dosing calculators for the management of continuous insulin infusions after cardiac surgery: A systematic review and meta-analysis.
abstract: OBJECTIVE
  To investigate the effectiveness of computerised insulin dosing calculators for the management of continuous insulin infusions in adult patients who underwent cardiac surgery.
  
  
  METHODS
  A systematic review was conducted. The CINAHL, MEDLINE and Cochrane databases were searched for primary studies that compared a computerised insulin dosing calculator to a paper protocol. The main outcome measures were mean Blood Glucose Level (BGL), time to achieve BGL target range, time spent within BGL target range, the incidence of hyperglycaemia and the incidence of hypoglycaemia.
  
  
  RESULTS
  Five studies were included in the final review. Pooled data demonstrated significant improvements in mean BGL (MD -14.24, 95% CI -26.93 to -1.55), p=0.03 and significantly lower rates of hypoglycaemia (OR 0.038, 95% CI: 0.16-0.90), p=0.03 amongst the computer calculator groups in comparison to the paper protocol groups. No significant difference in the incidence of severe hypoglycaemia was demonstrated (OR 0.21, 95% CI 0.02-1.79), p=0.15. No difference was found in time (hours) to reach target blood glucose range (MD -1.47, 95% CI -3.75 to 0.81), p=0.21.
  
  
  CONCLUSIONS
  There is some evidence to support the use of computerised insulin dosing calculators for insulin infusion management within critical care environments.
authors.affiliation: Centre for Research in Nursing and Health, St. George Hospital, Kogarah, Sydney, Australia; Centre for Evidence Based Initiatives in Health Care, A Collaborating Centre of The Joanna Briggs Institute, Australia. Electronic address: Megan.Higgs@health.nsw.gov.au.
authors.forename: Megan H
authors.initials: MH
authors.lastname: Higgs
authors.affiliation: Centre for Research in Nursing and Health, St. George Hospital, Kogarah, Sydney, Australia; Centre for Evidence Based Initiatives in Health Care, A Collaborating Centre of The Joanna Briggs Institute, Australia; School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Australia. Electronic address: Ritin.Fernandez@health.nsw.gov.au.
authors.forename: Ritin S
authors.initials: RS
authors.lastname: Fernandez
mesh_terms: D001786:Blood Glucose / Q000187:drug effects; D006348:Cardiac Surgical Procedures / Q000451:nursing; D000068598:Data Accuracy; D020000:Decision Support Systems, Clinical / Q000295:instrumentation*; D006801:Humans; D006943:Hyperglycemia / Q000178:diet therapy; D007260:Infusion Pumps / Q000592:standards; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use
chemical_list: D001786:Blood Glucose; D007328:Insulin
keywords: Cardiac surgery; Critical care; Hyperglycaemia; Insulin; Insulin infusion; Intensive care units; Meta-analysis; Systematic review