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Published Online, 18 May 2004, www.theannals.com, DOI 10.1345/aph.1E018.
 The Annals of Pharmacotherapy: Vol. 38, No. 7, pp. 1123-1129. DOI 10.1345/aph.1E018
© 2004 Harvey Whitney Books Company.
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CRITICAL CARE

INTRODUCTION: Les patients en post chirurgie cardiothoracique sont sujets à l'hyperglycémie et à un risque d'infection post-opératoire au site chirurgical. Un traitement agressif à l'insuline permettra l'atteinte d'un contrôle glycémique serré et l'amélioration des résultats.

OBJECTIF: Rapporter l'efficacité d'un protocole d'infusion d'insuline pour maintenir un contrôle glycémique étroit (CGE) entre 80–150 mg/dL auprès de patients post-chirurgie cardiothoracique.

MÉTHODOLOGIE: Un protocole d'infusion d'insuline initié par l'infirmière fut développé et utilisé auprès de patients avec ou sans diabète en post-chirurgie cardiaque. Dans cette étude, 2 périodes de mesures furent définies soit un état basal de 6 mois précédant le début du protocole d'infusion d'insuline (groupe contrôle, n = 174) suivi d'une période de 6 mois durant laquelle le protocole fut utilisé (groupe intervention, n = 168).

RÉSULTATS: Le pourcentage et le nombre de mesures de glycémie à l'intérieur du CGE (contrôle 47% vs intervention 61%; p = 0.001), l'aire sous la courbe de l'exposition glycémique >150 mg/dL en fonction du temps durant le premier 24 heures d'infusion d'insuline (contrôle 28.4 vs intervention 14.8, p <0.001), le temps médian pour l'atteinte d'une glycémie <150 mg/dL (contrôle 9.4 h vs intervention 2.1 h; p <0.001) et le pourcentage de glycémie <65 mg/dL étant un marqueur d'hypoglycémie (contrôle 9.8% vs intervention 16.7%; NS).

CONCLUSIONS: Un protocole d'infusion d'insuline développé pour atteindre une glycémie variant entre 80–150 mg/dL a permis d'améliorer le contrôle glycémique auprès de patients en post-chirurgie cardiothoracique sans toutefois augmenter l'incidence d'épisodes d'hypoglycémie.

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Copyright © 2004 by Harvey Whitney Books Company.