Evaluation of an electrolyte repletion protocol for cardiac surgery intensive care patients.

BACKGROUND

Implementation of electrolyte repletion protocols to facilitate and ensure the safety of electrolyte control is common practice in intensive care units (ICUs). However, few protocols have been evaluated and validated.

OBJECTIVE

To evaluate the effectiveness and safety of an electrolyte repletion protocol in a large, homogeneous group of postoperative patients.

METHODS

A retrospective study of patients admitted to the surgical ICU following coronary artery bypass grafting or heart valve replacement was undertaken at the Centre hospitalier universitaire de Sherbrooke, a 682-bed tertiary care hospital in Sherbrooke, Quebec. The proportion of measured values for serum potassium concentration that were within the desired range was compared between patients treated according to the electrolyte repletion protocol and those treated with the traditional approach to electrolyte repletion. Management of magnesium, phosphorus, and ionized calcium balance was also compared. The incidence of cardiac arrhythmias was documented, and the safety of the electrolyte repletion protocol was evaluated by determining and comparing proportions of values for serum electrolyte concentration that were above the desired range.

RESULTS

In total, 627 patients were included in the study: 312 in the control group and 315 in the protocol group. The proportion of patients with 100% of morning values for serum potassium concentration within the normal range was significantly higher in the protocol group than in the control group (66.1% versus 56.8%; p = 0.018). In the protocol group, significantly more patients received one or more replacement doses of magnesium and phosphorus (p < 0.001). The proportions of serum electrolyte values above the normal range were similar between the 2 groups, and there was no difference in the incidence of cardiac arrhythmias.

CONCLUSIONS

The electrolyte repletion protocol was more efficacious than traditional electrolyte repletion in maintaining normal serum potassium concentration and was safe.