The Effect of Tight Glycemic Control on Surgical Site Infection Rates in Patients Undergoing Open Heart Surgery
Diabetes, Hyperglycemia, Surgical Site Infection
About this trial
This is an interventional prevention trial for Diabetes focused on measuring Glycemic control
Eligibility Criteria
Inclusion Criteria:
- over the age of 21
- on cardiopulmonary bypass or off cardiopulmonary
- elective or urgent coronary artery bypass graft (CABG) surgery
- CABG with or without combined valve surgery
- valve surgery
Exclusion Criteria:
- chronically immunosuppressed
- suffered from end-stage organ disease
- currently had active infections
- underwent emergent or salvage CABG surgery
- had an implanted insulin pump
- were in another interventional clinical trial.
Sites / Locations
- James A. Haley VAH
Arms of the Study
Arm 1
Arm 2
Arm 3
Experimental
Experimental
Experimental
Tight Glycemic Group
Conventional Glycemic Group
Standard Glycemic Group
The tight glycemic group received a continuous intravenous infusion of regular insulin in the intraoperative period titrated per a modified Portland Protocol from Vanderbilt University Medical Center, Tennessee. The initial bolus of insulin and insulin infusion was initiated prior to induction of anesthesia if the morning blood glucose was greater than 149 mg/dl or any time intraoperatively the blood glucose elevated above 149 mg/dl.The titration of insulin for the tight glycemic group maintained blood glucose levels between 110-149 mg/dl throughout the intraoperative period. The intraoperative blood glucose was titrated to blood glucose levels sampled every 30 minutes.Upon transfer to the intensive care unit the protocol ended and all subjects received the same glycemic control.
The conventional glycemic group received a continuous intravenous infusion of regular insulin in the intraoperative period titrated per a modified Portland Protocol from Vanderbilt University Medical Center, Tennessee. The initial insulin bolus and infusion was initiated prior to induction of anesthesia if the morning blood glucose was greater than 180 mg/dl or any time intraoperatively that the blood glucose elevated above 180 mg/dl. The insulin infusion was titrated throughout the intraoperative period to maintain blood glucose levels between 150-180 mg/dl.The intraoperative blood glucose was titrated to blood glucose levels sampled every 30 minutes. Upon transfer to the ICU the intraoperative protocol ended and all subjects received the standardized glycemic control for the ICU.
The standard glycemic group received intravenous injections of regular insulin in the intraoperative period titrated per the usual care protocol utilized at the study site. The initial bolus of insulin was initiated prior to induction of anesthesia if the morning blood glucose is greater than 180 mg/dl or any time intraoperatively that the blood glucose rises above 180 mg/dl. The intraoperative blood glucose was titrated to blood glucose levels sampled every 30 minutes.Upon transfer to the ICU the intraoperative protocol ended and all subjects received the standardized glycemic control for the ICU.