Controlling Intraoperative Hyperglycemia in the Cardiac Surgical Patient using the Computerized Electronic Insulin Dose Calculator- A Quality Improvement Project

Abstract Purpose: 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. Methods A pilot and a modified EIC were sequentially implemented in adult patients undergoing cardiopulmonary bypass (CPB) procedures. Outcome measures (average blood glucose 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, pilot and modified EIC periods. Results The EIC was implemented in 97% of patients during the pilot period and in 86% of patients during the modified EIC period. Average blood glucose levels on CPB were the highest during the EIC period compared with pilot and baseline (184 mg/dl, vs. 180 mg/dl vs. 176 mg/dl, respectively, p=0.006). Mean blood glucose values at procedure end (123 mg/dl vs.123 mg/dl, vs. 173 mg/dl, respectively, p=<0.001) and first at ICU (141 mg/dl, vs.147 mg/dl, vs.157 mg/dl, respectively p= <0.001) were significantly reduced during the modified EIC and pilot periods compared with baseline. Hypoglycemia was significantly lower during EIC periods compared with baseline (1% vs. 7%, p=0.008). Less insulin units were used during the pilot and modified EIC periods compared to baseline (16.5U vs.16U, vs. 23U, respectively, p=0.006). Conclusion These preliminary findings suggest EIC effectiveness in reducing intraoperative hyperglycemia in patients undergoing CPB.