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Related Experiment Videos

Implementing tight glucose control after coronary artery bypass surgery.

Justine M Carr1, Frank W Sellke, Michelle Fey

  • 1Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA. jcarr@bidmc.harvard.edu

The Annals of Thoracic Surgery
|August 27, 2005
PubMed
Summary

Implementing a strict glucose control protocol for cardiac surgery patients significantly reduced mediastinitis rates. This approach, using a 110 mg/dL insulin trigger, proved effective in managing blood sugar and improving patient outcomes.

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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.

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  • 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.