Stepwise control of blood sugar after cardiac surgery- Qatari experience
Ahmed Mohamed Salama Abdelsalam1, Amro Salah Omar1, Mahmoud Ismail Allam1, Yasser Elgohry1, Shaban Mohammed2, Alejandro Kohn Tuli1, Rajvir Singh3
1Department of Cardiothoracic Surgery/Cardiac Anaesthesia & ICU Section, Heart Hospital, Hamad Medical Corporation, Doha, (PO:
30
50), Qatar
2Department of Clinical Pharmacy, Hamad Medical Corporation, Doha, Qatar
3Department of Medial Research, Hamad Medical Corporation, Doha, Qatar
BACKGROUND: Optimal glycemic control in postoperative cardiac patients is still under debate. In an attempt to reduce wound infection, and improving overall mortality variable targets had been prescribed. Aim of the work: To study the outcome of glucose control, with a target of 6 to 8.1mmol/L, and the associated factors related to poor control. METHODOLOGY: We evaluated 227 consecutive patients after cardiac surgery in a prospective descriptive study. Patients subjected to insulin infusion with a target of 6 to 8.1mmol/L. Data collected including demography, Euro score, cardiopulmonary bypass time (CPB), aortic cross clamp time (ACC), length of ventilation, stay in intensive care unit (ICU) and hospital and nurses compliance to follow the protocol. Patients divided into 2 groups according to the success of maintaining the target into: group I (target maintained over 80% of the time), and group II (target maintained in less than 80 % of the time). RESULTS: Both groups were matched regarding the age, sex, gender, and Euro score. Failure to lie within the target was significantly higher in diabetics (p=0.001), patients with HbA1c above 8% (p=0.0001), dopamine and adrenaline users (p=0.04&0.05 respectively). No significant difference found between the ethnic groups. CPB, and ACC time, lengths of stay ICU and ventilation were significantly higher in group II. Incidence of hypoglycemia, acute kidney injury, and hospital mortality were comparable both groups, although wound infections were higher in group II. CONCLUSION: Pertinent aspects did not affect blood sugar control; however high HbA1C is a good predictor of poor control. Patients with proper glucose control had a better outcome in terms of wound infection, lengths of ventilation and ICU stay with in-frequent hypoglycemic events as claimed. . ID: HMC 13169/13
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