Benefits of intensive insulin therapy in post-operative intensive care patients

Faculty of Health and Social Care, Edge Hill University, Ormskirk, Lancashire.
Nursing standard: official newspaper of the Royal College of Nursing 12/2012; 27(14):35-40. DOI: 10.7748/ns2012.
Source: PubMed


Patients without diabetes who have surgery often develop elevated blood glucose levels. This article describes the effects of stress on blood glucose levels and the importance of treating stress-induced hyperglycaemia in surgical patients. It suggests that all patients with or without diabetes could benefit from the maintenance of strict blood glucose control within set parameters during and after surgery. The evidence suggests that strict control of blood glucose levels and frequent monitoring and maintenance of normoglycaemia may reduce post-operative complications and promote better patient long-term outcomes. The use of intensive insulin therapy is recommended for all post-operative patients in intensive care.

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    ABSTRACT: The role of hyperglycaemia in the pathogenesis of myocardial damage during cardiac surgery or patients with acute coronary syndromes has been the subject of increasing interest over the past few years. Several further trials and meta-analyses investigating the role of insulin treatment, either aimed at tight control of blood glucose concentration or as part of a regimen including glucose and potassium, have been reported recently and are the subject of this review. Good control of blood glucose has been demonstrated to improve outcomes for diabetic patients undergoing cardiac surgery and following acute myocardial infarction. In surgical intensive care patients, tight glucose control improved mortality--a finding that is awaiting confirmation in multicentre studies. The use of glucose-insulin-potassium regimens does not improve outcomes in patients with acute myocardial infarction who have undergone reperfusion therapy, but may be beneficial during cardiac surgery. Tight control of blood glucose has been shown to be beneficial in several patient groups. The optimal target glucose concentration and glucose and insulin regimens remain to be confirmed or determined in each clinical situation.
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