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Published on: June 11, 2012
Intensive perioperative glucose control does not improve outcomes of patients submitted to open-heart surgery: a
Raquel Pei Chen Chan1, Filomena Regina Barbosa Gomes Galas, Ludhmila Abrahão Hajjar
1Department of Anesthesia and Surgical Intensive Care Unit, Instituto do Coração (InCor) , Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo.
Insights
Maintaining strict or moderate glucose control in cardiac surgery patients undergoing cardiopulmonary bypass did not significantly alter clinical outcomes. Both glycemic control strategies were found to be safe and achievable.
Area of Science:
- Cardiology
- Endocrinology
- Critical Care Medicine
Background:
- Cardiac surgery patients often experience glycemic variability.
- Maintaining optimal blood glucose levels is crucial for patient outcomes.
Purpose of the Study:
- To investigate the impact of two different target glucose levels on clinical outcomes in patients undergoing cardiac surgery with cardiopulmonary bypass.
- To compare the safety and efficacy of strict versus moderate glycemic control protocols.
Main Methods:
- A prospective study involving 109 patients undergoing open-heart surgery.
- Random allocation into two groups: target glucose 80-130 mg/dl or 160-200 mg/dl.
- Glucose control maintained during surgery and for 36 hours postoperatively.
Main Results:
- Mean glucose levels differed significantly between groups (126.69 mg/dl vs. 168.21 mg/dl).
- No significant differences observed in mechanical ventilation duration, ICU stay, infection rates, hypoglycemia, renal/neurological dysfunction, or 30-day mortality.
- Both glycemic control protocols were equally safe and effective.
Conclusions:
- Both strict (80-130 mg/dl) and moderate (160-200 mg/dl) glycemic control protocols are safe and achievable in cardiac surgery patients.
- Neither protocol demonstrated a differential impact on key clinical outcomes.
- Glycemic control strategies can be implemented without adversely affecting patient recovery.
Background:
The objective of this study was to investigate the relationship between different target levels of glucose and the clinical outcomes of patients undergoing cardiac surgery with cardiopulmonary bypass.
Methods:
We designed a prospective study in a university hospital where 109 consecutive patients were enrolled during a six-month period. All patients were scheduled for open-heart surgery requiring cardiopulmonary bypass. Patients were randomly allocated into two groups. One group consisted of 55 patients and had a target glucose level of 80-130 mg/dl, while the other contained 54 patients and had a target glucose level of 160-200 mg/dl. These parameters were controlled during surgery and for 36 hours after surgery in the intensive care unit. Primary outcomes were clinical outcomes, including time of mechanical ventilation, length of stay in the intensive care unit, infection, hypoglycemia, renal or neurological dysfunction, blood transfusion and length of stay in the hospital. The secondary outcome was a combined end-point (mortality at 30 days, infection or length of stay in the intensive care unit of more than 3 days). A p-value of <0.05 was considered significant.
Results:
The anthropometric and clinical characteristics of the patients from each group were similar, except for weight and body mass index. The mean glucose level during the protocol period was 126.69 mg/dl in the treated group and 168.21 mg/dl in the control group (p<0.0016). There were no differences between groups regarding clinical outcomes, including the duration of mechanical ventilation, length of stay in the intensive care unit, blood transfusion, postoperative infection, hypoglycemic event, neurological dysfunction or 30-day mortality (p>0.05).
Conclusions:
In 109 patients undergoing cardiac surgery with cardiopulmonary bypass, both protocols of glycemic control in an intraoperative setting and in the intensive care unit were found to be safe, easily achieved and not to differentially affect clinical outcomes.
