Glycemic control in cardiac surgery: implementing an evidence-based insulin infusion protocol

Area of Science:

• Critical Care Medicine
• Endocrinology
• Surgical Nursing

Background:

• Acute hyperglycemia post-cardiac surgery elevates risks of deep sternal wound infection, morbidity, and mortality.
• Previous insulin protocols targeting tight glycemic control were associated with hypoglycemia and increased mortality.
• Current guidelines support moderate glycemic control in critical illness.

Purpose of the Study:

• To assess critical care nurses' knowledge of glycemic control in cardiac surgery patients before and after an educational intervention.
• To evaluate the safety and effectiveness of an evidence-based insulin infusion protocol for moderate glycemic control in cardiac surgery patients.

Main Methods:

• An evidence-based practice change was implemented in a cardiovascular unit.
• Nurses' knowledge was measured using a pre- and post-education questionnaire.
• Retrospective blood glucose data from postoperative day 2 were compared before and after the intervention.

Main Results:

• Nurses' knowledge scores significantly increased post-education (pretest mean=53.10, posttest mean=79.10, P < .001).
• Mean blood glucose level post-intervention was 148 mg/dL, with 88.30% of levels below 180 mg/dL.
• The incidence of hypoglycemia significantly decreased from 2.09% to 0.22% (P < .001).

Conclusions:

• Enhanced nurses' knowledge of glycemic control improves patient management.
• Implementing a moderate glycemic control protocol is effective in treating hyperglycemia post-cardiac surgery.
• This approach reduces the incidence of hypoglycemia, enhancing patient safety.