Objective

This prospective, randomized trial compares use of a paper protocol to a computer-guided glucose management system (EndoTool) for cardiac surgery patients receiving intravenous insulin.

Setting

1425-bed teaching hospital and Level 1 trauma center.

Results

• Percentage of blood glucoses in the desired range of 90-150 mg/dL was 81.5% higher with EndoTool during the intra-operative phase (49% vs 27%) and 40% higher during the post-operative ICU phase (84% vs 60%).
• Time in the desired range was 89% higher with EndoTool during the intra-operative phase (121 vs 64 minutes) and 42.2% higher during the post-operative ICU phase (536 vs 377 minutes).
• Time to a target blood glucose <150 mg/dL was 31.9% lower with EndoTool during the intra-operative phase (62 vs 91 minutes) and 76% lower during the post-operative ICU phase (40 vs 171 minutes).
• Overall mean average blood glucose was 30 mg/dL lower with EndoTool during the intra-operative phase (147 vs 177 mg/dL) and 21 mg/dL lower during the post-operative ICU phase (126 vs 147 mg/dL).

Conclusions

A computer-guided glucose management system (EndoTool) achieves effective and safe blood glucose control in the ICU population both during and after cardiac surgery, and more rapid and tighter glucose control than a paper protocol.