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Correspondence

Computerized Euglycemia in Cardiovascular and Thoracic Surgery

Adult and Pediatric Cardiovascular Critical Care, Carolinas Heart and Vascular Institute, PO Box 32861, Charlotte, NC 28232

(Email: kevin.lobdell{at}carolinashealthcare.org).

To the Editor:

The EndoTool Glucose Management System (EGMS) (Hospira Inc, Lake Forest, IL) warrants consideration, despite exclusion from the report by The Society of Thoracic Surgeons Workforce by Lazar and colleagues [1] (list of published and commercially available variable rate insulin infusion protocols). The EGMS uses feedback control mathematics, which has been routinely used at the Carolinas Heart and Vascular Institute (approved by the Food and Drug Administration on 20 June 2006 and presently commercially available from Hospira, Inc) in over 4,000 adult cardiovascular surgery patients, and it is a cornerstone of our quality improvement program [2, 3] which has significantly mitigated the risk of death and complications. The algorithm used in the EGMS controls a nonlinear insulin-dosing relationship for each patient based on the response of the patient's trend of up to the last four insulin and glucose responses, resulting in safe, prompt euglycemia in both diabetics and nondiabetics. In our cardiovascular recovery unit, the mean glucose of all glucose readings is 117 mg/dL, with an incidence of profound hypoglycemia (40 mg/dL) of less than 0.1% of readings and less than 2% of patients [4]. The majority of hypoglycemia relates to tardy point-of-care glucose testing.

	References

Top References

 

1. Lazar HL, McDonnell M, Chipkin SR, et al. The Society of Thoracic Surgeons practice guideline series: blood glucose management during adult cardiac surgery Ann Thorac Surg 2009;87:663-669.[Free Full Text]
2. Stamou SC, Camp SL, Stiegel RM, et al. Quality improvement program decreases mortality after cardiac surgery J Thorac Cardiovasc Surg 2008;136:494-499.[Abstract/Free Full Text]
3. Stamou SC, Camp SL, Reames MR, et al. Continuous quality improvement program and major morbidity after cardiac surgery Am J Card 2008;102:772-777.[Medline]
4. Lobdell KW, Burgess WP, Geller HS. EndoTool software for glucose control in thoracic surgery patients. ATS 2007 International Conference, San Francisco, CA. Abstract A596.

This article has been cited by other articles:

				H. L. Lazar Reply Ann. Thorac. Surg., September 1, 2009; 88(3): 1049 - 1049. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Kevin W. Lobdell Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lobdell, K. W. Search for Related Content PubMed PubMed Citation Articles by Lobdell, K. W. Related Collections Cardiac - pharmacology Professional affairs Related Article