Implementing tight glucose control after coronary artery bypass surgery.

Area of Science:

• Cardiology
• Endocrinology
• Surgical Infection Prevention

Background:

• Tight glucose control offers clinical benefits for diabetic patients.
• Implementing such control in cardiac surgery presents challenges in definition, measurement, and variable assessment.
• Sternal wound infections are a concern in cardiac surgery patients.

Purpose of the Study:

• To implement and evaluate a tight glucose control protocol for cardiac surgery patients.
• To reduce sternal wound infections through improved glycemic management.
• To identify factors influencing glucose control in this patient population.

Main Methods:

• An interdisciplinary team developed and applied an insulin protocol for perioperative and intensive care unit management.
• Good glucose control was defined as maintaining blood glucose below 130 mg/dL for over 50% of measured time.
• The insulin initiation trigger was sequentially lowered from 150 mg/dL to 110 mg/dL.

Main Results:

• 90% of 818 coronary artery bypass grafting patients received insulin; 57% were not preoperatively diagnosed with diabetes.
• A protocol with a 110 mg/dL trigger was the strongest predictor of good glucose control (p < 0.001).
• Mediastinitis rates decreased from 1.6% to 0% during protocol implementation.

Conclusions:

• A standardized protocol and performance metrics are crucial for successful tight glucose control.
• This practice enhanced glycemic control and significantly reduced mediastinitis incidence.
• Patient-specific factors did not significantly impact glucose control under the protocol.