Zaky Ahmed, Novak Zdenek, Roberson Tinsley, Hatter Brittany, Benz David L, Panayotis Vardas, Boutwell Gary, Bode John, Stewart Hayden, Alsip Jorge A, Lemak Christy
Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
Division of Cardiothoracic and Critical Care Anesthesiology, University of Alabama at Birmingham, 950 Jefferson Tower, 625 19th Street South, Birmingham, AL, 35249-6810, USA.
Sci Rep. 2025 Aug 29;15(1):31930. doi: 10.1038/s41598-025-17806-4.
Perioperative hyperglycemia is associated with increased morbidity and mortality. We report the findings of our quality improvement project on the use of an electronic insulin dosing calculator (EIC) to reduce intraoperative hyperglycemia in a cohort of cardiac surgical patients. A pilot and a modified EIC were sequentially implemented in adult patients undergoing cardiopulmonary bypass (CPB) procedures. Outcome measures (average blood glucose (BG) before, during and after CPB), process measures (percent EIC implementation) and balancing measures (incidence of hypoglycemia and average insulin doses utilized) were compared between baseline (no-protocol), pilot and modified EIC periods. 248, 142, and 239 patients were enrolled during the baseline, pilot and modified EIC phases, respectively. The EIC was implemented in 97% (138 out of 142 patients) during the pilot phase and in 86% of patients (206 out of 240 patients) during the modified EIC phase. Average BG levels on CPB were highest at baseline compared with pilot and modified EIC phases (mean, SD, 209 mg/dl,+/-45), vs. 189.8,+/-38 mg/dl vs. 188 mg/dl, +/-40) mg/dl, respectively, p = 0.002). Mean BG values were highest at baseline compared to pilot and modified EIC phases at end of procedure (182.4, +/-49 mg/dl, vs. 122, +/-30 mg/dl, vs.123.3, mg/dl, +/-38.3, vs., respectively, p = < 0.001) and at the ICU (164 ,+/-44.4, mg/dl, vs. 140, +/-37.9 mg/dl, vs. 143.4, +/-36 mg/dl, respectively p = < 0.001). Hypoglycemia was significantly lower during EIC phase compared with baseline (1% vs. 7%, p = 0.008). Less insulin was used during the pilot and modified EIC phases compared to baseline (15.2, +/-10.3, U vs. 15.8, +/-10.2 U, vs. 31.6 +/-20.27 U, respectively, p = 0.006). These preliminary findings suggest EIC effectiveness in reducing intraoperative hyperglycemia in patients undergoing CPB.
围手术期高血糖与发病率和死亡率增加相关。我们报告了关于使用电子胰岛素剂量计算器（EIC）以降低一组心脏手术患者术中高血糖的质量改进项目的研究结果。在接受体外循环（CPB）手术的成年患者中依次实施了一个试点版和一个改良版EIC。比较了基线期（无方案）、试点期和改良EIC期的结果指标（CPB前、期间和之后的平均血糖（BG））、过程指标（EIC实施百分比）和平衡指标（低血糖发生率和使用的平均胰岛素剂量）。在基线期、试点期和改良EIC期分别纳入了248例、142例和239例患者。在试点期，97%（142例患者中的138例）实施了EIC，在改良EIC期，86%的患者（240例患者中的206例）实施了EIC。与试点期和改良EIC期相比，CPB期间的平均BG水平在基线期最高（均值，标准差，209mg/dl，±45），分别为189.8，±38mg/dl和188mg/dl，±40mg/dl，p = 0.002）。与试点期和改良EIC期相比，手术结束时基线期的平均BG值最高（182.4，±49mg/dl，分别为122，±30mg/dl和123.3mg/dl，±38.3mg/dl，p = <0.001），在重症监护病房（ICU）也是如此（164，±44.4mg/dl，分别为140，±37.9mg/dl和143.4mg/dl，±36mg/dl，p = <0.001）。与基线期相比，EIC期的低血糖显著更低（1%对7%，p = 0.008）。与基线期相比，试点期和改良EIC期使用的胰岛素更少（分别为15.2，±10.3U对15.8，±10.2U对31.6±20.27U，p = 0.006）。这些初步研究结果表明EIC在降低接受CPB患者的术中高血糖方面有效。
