TY - JOUR
T1 - Strict versus liberal insulin therapy in the cardiac surgery patient
T2 - An evidence-based practice development, implementation and evaluation project
AU - Gordon, Jacqueline M.
AU - Lauver, Lori
AU - Buck, Harleah G.
PY - 2018/2/1
Y1 - 2018/2/1
N2 - Background Hyperglycemia post-cardiac surgery is associated with poor clinical outcomes. Recent studies suggest maintaining liberal glycemic control (< 180 mg/dL) using a continuous insulin infusion (CII) versus strict control achieves optimal outcomes and prevents hypoglycemia. Purpose To develop, implement and evaluate a nurse managed liberal CII protocol. Methods Retrospective review of 144 strict CII patient records and 147 liberal CII patient records. Results Mean blood glucose was 159.8 mg/dL (liberal CII) compared to 143.3 mg/dL (strict CII) (p ≤ 0.001). No surgical site infections occurred in either group. Mean ICU length of stay was 4.5 days (liberal) versus 4.4 days (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 24 h after surgery was 0.1% (liberal) compared to 0.3% (strict) compared to (p = 0.16). Conclusion Use of a nurse managed liberal CII resulted in similar outcomes with fewer incidents of hypoglycemia.
AB - Background Hyperglycemia post-cardiac surgery is associated with poor clinical outcomes. Recent studies suggest maintaining liberal glycemic control (< 180 mg/dL) using a continuous insulin infusion (CII) versus strict control achieves optimal outcomes and prevents hypoglycemia. Purpose To develop, implement and evaluate a nurse managed liberal CII protocol. Methods Retrospective review of 144 strict CII patient records and 147 liberal CII patient records. Results Mean blood glucose was 159.8 mg/dL (liberal CII) compared to 143.3 mg/dL (strict CII) (p ≤ 0.001). No surgical site infections occurred in either group. Mean ICU length of stay was 4.5 days (liberal) versus 4.4 days (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 24 h after surgery was 0.1% (liberal) compared to 0.3% (strict) compared to (p = 0.16). Conclusion Use of a nurse managed liberal CII resulted in similar outcomes with fewer incidents of hypoglycemia.
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U2 - 10.1016/j.apnr.2017.11.013
DO - 10.1016/j.apnr.2017.11.013
M3 - Article
C2 - 29422171
AN - SCOPUS:85037982095
VL - 39
SP - 265
EP - 269
JO - Applied Nursing Research
JF - Applied Nursing Research
SN - 0897-1897
ER -