Effectiveness of blood glucose control protocol for open-heart surgery patients

Controlling your blood sugar is more important than you think in the ICU…

Glycemic control for patients is considered one of the most important factors when treating patients in an intensive care unit. Hyperglycemia statistically is deemed to be related to increased mortality and or morbidity. It is also an important role when performing open-heart surgery. The ratio of insulin and controlling the blood sugar for the Patient is always essential. Two things that may be considered with glucose control for patients in the ICU setting are the incidence of hypoglycemia and the most frequent side effect of not controlling the blood glucose properly. Some studies show the relationship between optimal glucose control in the ICU setting results in fewer days in the hospital, which directly relates to a reduction in mortality. Yale did a study to reduce blood glucose. It was a randomized controlled study to control blood sugar within the intensive care unit. It was (NICE-SUGAR), and it involved 6,104 patients. They were divided into an intensive group with a target of 81-108 mg/dl for patients. The 90-day mortality rate was significantly lower within the treatment group than the control group, in which 6.8% of hypoglycemia happens less often. Previous studies such as this showed that glycemic control is essential for many situations such as COVID-19.

The study tries to tailor older studies and apply them to open-heart surgery patients in the ICU setting. The target levels of blood glucose were 110-150 mg/l, and Clinician’s used a single dose of insulin to intimate the continuous insulin injection. There would be hourly blood glucose monitoring for the first 3 hours, and patients would be calculated their insulin based on their blood sugar. This protocol is related to the yale study as they want to see the importance of glucose control and reduce mortality with patients in ICU heart surgery patients. They stressed the importance of the protocol and how all the doctors and nurses involved are actively trying to make a difference in their health. The purpose of this study was to evaluate the effectiveness of tailored blood glucose control for patients in ICU after they have done open-heart surgery. It was a retrospective study and was split between the treatment group and the non-treatment group. The study was conducted among patients who were 19 and older. The exclusion criteria were ICU patients in other departments and heart transplant patients who controlled blood glucose under the doctor’s supervision.

There was data collection with two studies that intensely monitored blood glucose for patients. The target blood glucose changed from 100-150 mg/dl to 100-180 mg/dl. So they were looking at a target level of anything below 180, which is a common standard inside the hospital setting. Reports found decreased mortality, infection rate, and length of stay in the (Dellinger study). Blood glucose was measured every 2 hours until the target level was reached and every 4 hours if the Patient’s glucose maintained the target level over time.

The data collection was split between the treatment group 376 patients and the non-treatment group 349 patients in ICU between April 2015- July 2015. In the results, 76.9% of Patients’ blood glucose was higher than the goal in the treatment group, but for the non-treatment group, 96.8% of patients have blood glucose more elevated than the target goal. The significance of the differences is very high and had a level of (t=-17.47, p <0.001). The incidence of hypoglycemia didn’t even occur in the treatment group. Overall the treatment group had better control of glucose of incidences of hypo and hyperglycemia. The study’s limitations were because it was done in a particular setting in south Korea recovering from heart surgery. It also only took into account blood glucose and clinical outcome, which didn’t account for other study comorbidities.

The author concluded that intense control of blood glucose based on measurement and insulin dose adjustment is essential for patients in critical care after open-heart surgery. It also shed light on increasing the workload on nurses in the ICU setting, which can bring a better result for patients in ICU. More studies are needed to be made, but it is a good start to knowing the importance of reducing mortality and morbidity in patients after open-heart surgery.

2020. Yoo, E. Suh. Effectiveness of blood glucose control protocol for open heart surgery patients. Leading global nursing research January 2020.

Idris Aderoju, Pharm.D. Candidate, Florida A&M University