Tight Glycemic Control Does Not Improve Pediatric Cardiac Surgery Outcomes

Tight glycemic control with insulin following pediatric cardiac surgery is achievable without a high risk of hypoglycemia, but it does not improve patient outcomes, according to results from the randomized SPECS study published in the Sept. 7 issue of The New England Journal of Medicine. In adult cardiac surgery patients, the administration of postoperative insulin has been associated with improved outcomes. However, among pediatric patients, postoperative insulin did not reduce the incidence of health care-associated infections, mortality or length of hospital stay.

"Infections are an important complication of surgery in patients of all ages. High blood sugar after surgery is a risk factor for adults and thus is aggressively treated. [However,] despite having high blood sugar after surgery, aggressive management does not alter outcomes [in children]," said Gerard Martin, MD, co-director, Children’s National Heart Institute, Children’s National Medical Center, Washington, D.C., and a member of the ACC Board of Trustees.


The SPECS prospective, randomized trial enrolled 980 children between 0 and 36 months of age undergoing surgery with cardiopulmonary bypass. Among patients randomized to tight glycemic control, normoglycemia was achieved faster (6 hours versus 16 hours, p < 0.001) and maintained for a greater proportion of the critical illness, defined as the presence of an arterial catheter (50 percent vs. 33 percent, p < 0.001). However, 30 days post-randomization, there was no statistically significant difference in the rate of health care-associated infections between patients who received tight glycemic control and those who received standard care. The rates were 8.6 per 1,000 patient-days in the glycemic-control group vs. 9.9 per 1,000 patient-days in the standard-care group (p = 0.78). Likewise, there were no statistically significant differences in secondary outcomes like mortality, length of stay, organ failure and hypoglycemia.

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"This is an excellent article that addresses an important issue and … is another example that children are not small adults. We do not have to expose children to insulin drips for high blood sugar and risk hypoglycemic episodes," Martin said.

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