Intensive Perioperative Glucose Control Does Not Improve Outcomes of Patients Submitted to Open-Heart Surgery: A Randomized Controlled Trial

Abstract

BACKGROUND: The objective of this study was to investigate the relationship between different target levels of glucose and the clinical outcomes of patients undergoing cardiac surgery with cardiopulmonary bypass. METHODS: We designed a prospective study in a university hospital where 109 consecutive patients were enrolled during a six-month period. All patients were scheduled for open-heart surgery requiring cardiopulmonary bypass. Patients were randomly allocated into two groups. One group consisted of 55 patients and had a target glucose level of 80–130 mg/dl, while the other contained 54 patients and had a target glucose level of 160–200 mg/dl. These parameters were controlled during surgery and for 36 hours after surgery in the intensive care unit. Primary outcomes were clinical outcomes, including time of mechanical ventilation, length of stay in the intensive care unit, infection, hypoglycemia, renal or neurological dysfunction, blood transfusion and length of stay in the hospital. The secondary outcome was a combined end-point (mortality at 30 days, infection or length of stay in the intensive care unit of more than 3 days). A p-value of <0.05 was considered significant. RESULTS: The anthropometric and clinical characteristics of the patients from each group were similar, except for weight and body mass index. The mean glucose level during the protocol period was 126.69 mg/dl in the treated group and 168.21 mg/dl in the control group (p<0.0016). There were no differences between groups regarding clinical outcomes, including the duration of mechanical ventilation, length of stay in the intensive care unit, blood transfusion, postoperative infection, hypoglycemic event, neurological dysfunction or 30-day mortality (p>0.05). CONCLUSIONS: In 109 patients undergoing cardiac surgery with cardiopulmonary bypass, both protocols of glycemic control in an intraoperative setting and in the intensive care unit were found to be safe, easily achieved and not to differentially affect clinical outcomes.

Superiority of moderate control of hyperglycemia to tight control in patients undergoing coronary artery bypass grafting

“…These findings corroborate recent data from other specialties. 2,3,13,23 Acute ischemic stroke and myocardial infarction are both significantly increased among patients who have stress-induced hyperglycemia, irrespective of diabetes status. 24–27 It is well known that patients with diabetes have a lower mortality risk when admitted to the hospital than do patients without diabetes who have surges in glycemic index.…”

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

“…Our analysis included 14,495 patients from 27 studies 128, 330, 331, 332, 337, 338, 339, 340, 341, 342, 343, 344, 345, 346, 347, 348, 349, 350, 351, 352, 353, 354, 355, 356, 357, 358, 359. None of the studies were especially prone to bias.…”

Infusão de insulina em terapia intensiva: ensaio controlado randomizado

“…In Brazil, a study conducted with pa ents undergoing cardiac surgeries iden fi ed similar glycemic means, also no ng a sta s cally signifi cant diff erence (p<0.0016) between the study groups (17) . Considering that the objec ve of the intensive group was to maintain glycemic levels between 80-110mg/dl, and between 180-220mg/dl in the conven onal group, it can be said that the mean glycemic levels obtained in the intensive group approached the expected and the conven onal group remained with results below the range recommended by the protocol.…”