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A Randomized Study in Diabetic Patients Undergoing Cardiac Surgery Comparing Computer-Guided Glucose Management With a Standard Sliding Scale Protocol
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.
Authors
Leif Saager, MD; Gordon Collins, MD; Beth Burnside, BA; Heidi Tymkew, MHS; Lini Zhang, MD; Eric Jacobsohn, MBChB, MHPE, FRCPC; Michael Avidan, MBBCh, FCA.
Source
Published in Journal of Cardiothoracic and Vascular Anesthesia, Volume 22, Issue 3, p377-382.
Year
2008
Tags
- Cost Savings
- Healthcare-Associated Infections
- Hospital-Acquired Conditions
- Hyperglycemia Reduction
- Hypoglycemia Reduction
- Length of Stay
- Surgical Site Infections
- Glucose Variability
- Mean Glucose Improvement
- Target Goal Attainment
- Time in Range
- Time on IV Insulin
- Time to Target
- Burn Injury
- Cardiac Surgery
- DKA/HHS Management
- Emergency Department
- Induced Hypothermia
- Intra-op Glucose Management
- Obstetrics/Labor & Delivery
- Pediatrics
- Residual Insulin Adjustment
- BG Check Compliance
- BG Test Reduction
- Nursing Satisfaction
- Protocol Adherence
- Provider Satisfaction
- Workflow Improvements