Comparison of the Leuven Protocol With the Glucommander for Postoperative Control of Blood Glucose With IV Insulin
Comparison of the Leuven Protocol With the Glucommander for Postoperative Control of Blood Glucose With IV Insulin
The investigators are testing whether a written protocol or a computerized program can more
 effectively control blood glucose after surgery.
In 2002 we adapted the protocol described by Van den Berghe et al. for use in our own
 surgical intensive care unit (SICU) with a target blood glucose range from 80 to 120mg/dL.
 After five years of implementation, we were able to achieve a mean BG of 117 mg/dL in the
 SICU. 2% of glucose values were <60 mg/dL in the SICU. Given the concern of safety while
 optimizing glycemic control, we investigated the etiologies for these hypoglycemic episodes
 and have found two frequent risk factors; the failure to consistently measure blood glucose
 every hour and in patients with end stage renal failure.

 We will investigate whether a computer-based algorithm for the titration of IV insulin will
 translate to better clinical outcomes and less hypoglycemia. Therefore, we will conduct a
 prospective randomized trial comparing the Glucommander, a computer-based algorithm with our
 Van den Berghe protocol for titration of IV insulin in patients after cardiovascular or
 transplant surgery. This computer based algorithm was invented in 1984 in Atlanta by Dr.
 Davidson and Dr. Steed who have used it in a variety of applications of IV insulin.
Inclusion Criteria:

 -  s/p open heart or kidney or liver transplant surgery

 Exclusion Criteria:

 -  admission blood glucose less than 120 mg/dl