ABSTRACT
OBJECTIVE: Perioperative poor glycemic control in diabetic patients undergoing Coronary Artery Bypass Graft (CABG) surgery has been associated with infectious complications, particularly surgical site infections that are linked with adverse health surgical outcomes. The purpose of this study was to investigate the effect of two different intraoperative glycemic control protocol, tight and conventional, on thirty-day postoperative surgical site infection (SSI) rates among diabetic patients undergoing CABG surgery. DESIGN: A randomized controlled trial (RCT) design was employed in the study, with a convenience sample of 144 adult patients who were scheduled to undergo coronary artery bypass grafting surgery. SETTING: A main referral heart institute in Amman, Jordan. PARTICIPANTS: Subjects were randomly assigned to either the tight glycemic control group (n = 72), which maintained an intraoperative blood glucose level of 110-149 mg/dl via continuous intravenous insulin infusion, or the conventional glycemic control group (n = 72), which maintained an intraoperative blood glucose level of 150-180 mg/dl via continuous intravenous insulin infusion. The postoperative SSIs among both groups were evaluated and compared by independent blinded physicians. RESULTS: The primary findings of this study indicated no statistically significant difference between the two treatment groups in terms of SSI rates and their potential adverse surgical outcomes (p = 0.512). CONCLUSION: Nurses should consider the glycemic stability and glycemic control approach to minimize adverse surgical outcomes post CABG surgery. Healthcare providers should also carefully consider diabetic patients who have undergone CABG surgery and are at risk of developing postoperative SSIs. CLINICALTRIALSGOV IDENTIFIER: NCT04451655 was retrospectively registered in 30/06/2020.
ABSTRACT
BACKGROUND: Intraoperative glycaemic stability and control among patients with diabetes mellitus (DM) undergoing coronary artery bypass grafting (CABG) surgery have been a major concern. The current study aimed to compare the effect of tight glycaemic control and conventional glycaemic control on glycaemic stability and length of stay (LOS) among diabetic patients undergoing CABG surgery. METHODS: This study utilised a randomised control trial design among a convenience sample of 144 patients. Participants were randomly assigned to either the tight or conventional glycaemic control groups. The repeated measures analysis of variance (ANOVA) test and an independent samples t test were used to assess the variations in blood glucose (BG) level and LOS based on insulin therapy type. RESULTS: Patients who received the tight glycaemic control protocol had significantly more consistent and lower mean intraoperative BG levels than did patients who received the conventional glycaemic control protocol. No statistically significant differences in hospital LOS in days were identified between the two groups. CONCLUSION: Healthcare providers, including physicians and nurses, should consider using tight glycaemic control therapy among patients undergoing coronary artery bypass graft (CABG) surgery. This may lead to increased BG level consistency and stability and lower mean intraoperative BG level across time.
Subject(s)
Blood Glucose , Diabetes Mellitus , Coronary Artery Bypass , Glycemic Control , Humans , Length of Stay , Randomized Controlled Trials as TopicABSTRACT
INTRODUCTION: Biofilm in chronic wounds impedes the wound healing process. Each biofilm has differing characteristics requiring a multifaceted approach for removal while maintaining a surrounding environment conducive to wound healing. OBJECTIVE: In this study, 3 of the components in a wound cleanser are tested to determine synergy in eradicating biofilms of methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa in vitro. MATERIALS AND METHODS: The 3 components assessed for synergy were ethylenediamine tetraacetic acid sodium salts (EDTA), vicinal diols (VD; ethylhexylglycerin and octane-1,2-diol), and polyhexamethylene biguanide (PHMB). Each component was assessed individually and in combination while dissolved in a base solution. The Calgary assay method was used for biofilm growth and treatment. Kull Equation analysis for synergy was conducted using viable count results. RESULTS: Synergy is defined as the interaction of components to produce a combined effect greater than the sum of their separate effects. The base solution containing all 3 components (EDTA, VD, and PHMB) reduced biofilm viability by more than 5 logs, demonstrating statistically significant synergy. The 3 components tested individually in the base solution resulted in the following: EDTA did not reduce bacteria viability; VD reduced viability by about 1 log; and PHMB reduced P aeruginosa viability by about 2.5 logs and MRSA viability by about 4 logs. Of importance, the MRSA biofilm failed to regrow in the recovery plates after combined treatment, indicating complete elimination of the biofilm bacteria. CONCLUSIONS: The experimental and calculated results indicate the 3 components (VD, EDTA, and PHMB) when used together act synergistically to eradicate MRSA and P aeruginosa biofilms in vitro.
