Glycemic control in cardiac surgery patients

Recent evidence has been disappointing concerning tight glycemic control in the general critically ill population, and the suggested threshold for intervention is now 180mg/dl. Different considerations may apply in special populations, and for cardiac surgery patients the target is unclear. A new literature review of glycemic control post cardiac surgery, published in the Baylor University Medical Center Proceedings, concluded thusly:

Based on recent information, the new Society of Thoracic Surgeons guidelines and the AACE/ADA consensus statement seem appropriate and allay the concern for hypoglycemia with the new recommended range of less than180 and 140 to 180 mg/dL. More studies analyzing blood glucose target ranges seem necessary to further recommend an intensive blood glucose goal range of 80 to 110 mg/dL, especially in the cardiac surgery population. Even throughout the Van Den Berghe trials, the average blood sugar of patients in the intensive control arm was approximately 140 mg/dL. Thus, aiming for blood glucose levels around 140 mg/dL appears reasonable. Mortality and morbidity benefits are seen with overall control of hyperglycemia; however, the exact range is still not clearly defined, as previously thought.