Original ArticlesContinuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures☆
Section snippets
Patients
All known diabetic patients consecutively admitted to Portland St Vincent Medical Center for open heart surgical procedures between January 1987 and November 1997 were entered into the study (n = 2,467). Historical, demographic, and surgical variables that might possibly be associated with infectious complications were collected in a common database. These variables included age, sex, height, weight, race, type of preoperative diabetic control (insulin, oral, diet, or none), steroid use,
Demographics
Between January 1987 and November 1997, 14,468 patients underwent open heart surgical procedures through median sternotomy at St Vincent Medical Center. Seventeen percent of these patients (n = 2,467) were classified as diabetic at the time of admission, and all were enrolled in the study. Mean age was 65 ± 10 years, and 62% of patients were men. The cardiac procedures performed in this diabetic cohort included coronary artery bypass grafting in 2,117 patients, valve replacements in 158,
Comment
The present study reconfirms our previous finding [6] that hyperglycemia in the first 2 PODs is significantly associated with, and is an independent predictor of, DSWI (Table 4). These data indicate that hyperglycemia after cardiac operation in the diabetic patient may actually be a causal factor in that infectious process as well. When postoperative hyperglycemia was manipulated through an aggressive intravenous insulin infusion aimed at maintaining glucose levels in the 150 to 200-mg/dL
Acknowledgements
We extend our sincere appreciation to Steven Bookin, MD, endocrinologist, for writing a continuous intravenous insulin protocol that could be safely and effectively implemented by the nursing staff. Appreciation is extended to Patti Luckerath, Chris Pollack, and Elissa Walsh for assistance with data collection. We also thank Cindy Fessler and Natasha Lodahl for their tireless assistance in the preparation of the manuscript, figures, and slides.
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