Abstract
BackgroundHyperglycemia post-cardiac surgery is associated with poor clinical outcomes. Recent studies suggest maintaining liberal glycemic control (<180mg/dL) using a continuous insulin infusion (CII) versus strict control achieves optimal outcomes and prevents hypoglycemia. PurposeTo develop, implement and evaluate a nurse managed liberal CII protocol. MethodsRetrospective review of 144 strict CII patient records and 147 liberal CII patient records. ResultsMean blood glucose was 159.8mg/dL (liberal CII) compared to 143.3mg/dL (strict CII) (p≤0.001). No surgical site infections occurred in either group. Mean ICU length of stay was 4.5days (liberal) versus 4.4days (strict) (p=0.74). Two 30-day mortalities occurred for the liberal cohort compared to no deaths in the strict group (p=0.49). Hypoglycemia incidence within 24h after surgery was 0.1% (liberal) compared to 0.3% (strict) compared to (p=0.16). ConclusionUse of a nurse managed liberal CII resulted in similar outcomes with fewer incidents of hypoglycemia.
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