Outcomes With Tight Control of Hyperglycemia in Cardiac Surgery Patients

Study Overview
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Brief Summary
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Patients with or without diabetes may have high blood sugar levels due to stress response of the body during heart surgery. This study is being done to determine if maintaining normal blood sugar levels during open-heart surgery by using intravenous insulin results in a lesser incidence of death, wound infections in the chest, disturbances of heart rhythm, kidney failure, stroke and prolonged time on the breathing machine (artificial ventilation) within 30 days after surgery.

Detailed Description
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Rigorous intraoperative glycemic control may be of paramount importance in affecting outcomes after cardiac surgery. There is evidence that strict control of glucose levels postoperatively results in improved outcomes in patients undergoing cardiac surgery. There is currently no consensus on optimal management of hyperglycemia intraoperatively. The aim of this prospective randomized controlled clinical trial is to determine whether normalization of intraoperative glucose levels with insulin improves outcomes. The comparison group will be treated with current standard practice to control hyperglycemia during surgery. The primary outcome is a composite of mortality, sternal wound infections, prolonged pulmonary ventilation, cardiac arrhythmias (new-onset atrial fibrillation, heart block requiring permanent pacemaker, cardiac arrest), stroke and acute or worsening renal failure within 30 days after surgery. Secondary outcome measures are length of intensive care unit and hospital stay as well as safety and efficacy of the study insulin infusion protocol.

Official Title
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Outcomes With Use Of Intensive Insulin Therapy In Intraoperative Management Of Hyperglycemia In Adult Patients Undergoing Cardiac Surgery

Conditions
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Cardiac Surgical Procedures, Hyperglycemia

Intervention / Treatment
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* Drug: Insulin infusion with a goal


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria All subjects accepted for this study must be: >=18 years of age Undergoing an elective cardiac surgical procedure Exclusion Criteria Subjects who have one or more of the following will be excluded from the study: Undergoing surgery not utilizing cardiopulmonary bypass Unable to grant informed consent or comply with study procedure Undergoing emergency open heart-surgery 3. Are allergic to any of the excipients in insulin

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Intervention/Treatment |
| --- |
|Drug: Insulin infusion with a goal|nan|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mortality |  |  | 
| Sternal wound infections |  |  | 
| Stroke |  |  | 
| Cardiac arrhythmias |  |  | 
| Renal failure |  |  | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Lenght of intensive care unit stay |  |  | 
| Length of hospital stay |  |  | 
| Safety of study insulin infusion |  |  | 
| Efficacy of study insulin infusion |  |  |