Issn Print: 0265-0215

Publication Date: 2010/06/12


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Effects of intensive intraoperative glycemic control on postoperative complications in patients undergoing cardiac surgery: A randomized trial: 4AP3–3

P. Rujirojindakul; T. Liabsuetrakul; E. McNeil; T. Chanchayanon; C. Rergkliang

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Background and Goal of Study: Hyperglycemia occurs commonly in patients with cardiac surgery, especially during cardiopulmonary bypass surgery. The poorer glycemic control has been associated with higher morbidity. This study sought to determine whether intensive glycemic control with modified glucoseinsulin-potassium (GIK) solution during cardiac surgery would improve perioperative and postoperative outcomes.
Materials and Methods: A prospective, randomized, double-blind trial was conducted at Songklanagarind Heart Center. One hundred and ninety-nine adult patients undergoing cardiac surgery with cardiopulmonary bypass were enrolled to receive GIK with a target glucose level of 80–150 mg/dL or a conventional treatment with blood glucose less than 250 mg/dL. The primary end point was the infection rate during admission and postoperative 30 day (D +30). The secondary outcomes were hypoglycemia, neurological or renal dysfunction, incidence of perioperative atrial fibrillation, duration of mechanical ventilation and length of hospital stay.
Results and Discussion: Mean glucose levels had been statistically significantly lower in the intensive glycemic treatment group from 60 minutes after induction to the end of surgery. The infection rate during admission and D +30 were 8.5 % and 3.0 %, respectively in the GIK group versus 7.1 % and 3.8 % in the control group (p = 0.76). Twenty out of 99 patients (20.2 %) in the intensive treatment group and 3 out of 100 patients (3.0 %) in the conventional treatment group developed hypoglycemia (p <0.001). Neurological dysfunction (3.0 % vs 1.2 %, p = 0.28), renal dysfunction (3.0% vs 3.5%, p = 0.95), incidence of atrial fibrillation (10.4 % vs 12.4 %, p = 0.69), duration of mechanical ventilation (median (IQR)) (19 hr. (16, 24.2) vs 20 hr. (15.5, 32), p = 0.69) and length of hospital stay (median (IQR)) (13 day (10, 17.2) vs 13 day (10, 17), p = 0.60) were similar for both groups. Mortality rate was 3.0 % in the intensive control group and 4.1 % in the standard control group (p = 0.82).
Conclusion(s): Intensive intraoperative glycemic control during cardiac surgery does not reduce the infection rate or morbidity. A significantly increased incidence of hypoglycemia and difficulty in achieving strict glycemic control in intensive insulin therapy should be considered for implementation of this protocol into routine practice.

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