***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: OBJECTIVE Recent studies suggest that strict perioperative glycemic control improves clinical outcomes after cardiothoracic surgery . However , optimal methods and targets for controlling blood glucose ( BG ) levels in this setting have not been established . Currently published intensive insulin infusion protocol s ( IIPs ) have important practical limitations , which may affect their utility . In this article , the authors present their experience with a safe , effective , nurse-driven IIP , which was implemented simultaneously in 2 cardiothoracic intensive care units ( CTICUs ) . DESIGN Prospect i ve cohort study . SETTING Tertiary referral hospital and community teaching hospital . PARTICIPANTS CTICU patients . INTERVENTIONS A st and ardized , intensive IIP was used for all patients admitted to both CTICUs .  Hourly BG levels , relevant baseline variables , and clinical interventions were collected prospect ively from the active hospital chart and CTICU nursing records . MEASUREMENTS AND MAIN RESULTS The IIP was used 137 times in 118 patients . The median time required to reach target BG levels ( 100 - 139 mg/dL ) was 5 hours . Once BG levels decreased below 140 mg/dL , 58 % of 2,242 subsequent hourly BG values fell within the narrow target range , 73 % within a " clinical ly desirable " range of 80 to 139 mg/dL , and 94 % within a " clinical ly acceptable " range of 80 to 199 mg/dL. Only 5 ( 0.2 % ) BG values were less than 60 mg/dL , with no associated adverse clinical events . CONCLUSIONS The IIP safely and effectively improved glycemic control in 2 CTICUs , with minimal hypoglycemia . Based on prior studies showing the benefits of strict glycemic control , the implementation of this IIP should help to reduce morbidity and mortality in CTICU patients Background —This study sought to determine whether tight glycemic control with a modified glucose-insulin-potassium ( GIK ) solution in diabetic coronary artery bypass graft ( CABG ) patients would improve perioperative outcomes . Methods and Results —One hundred forty-one diabetic patients undergoing CABG were prospect ively r and omized to tight glycemic control ( serum glucose , 125 to 200 mg/dL ) with GIK or st and ard therapy ( serum glucose < 250 mg/dL ) using intermittent subcutaneous insulin beginning before anesthesia and continuing for 12 hours after surgery . GIK patients had lower serum glucose levels ( 138±4 versus 260±6 mg/dL ; P < 0.0001 ) , a lower incidence of atrial fibrillation ( 16.6 % versus 42 % ; P = 0.0017 ) , and a shorter postoperative length of stay ( 6.5±0.1 versus 9.2±0.3 days ; P = 0.003 ) . GIK patients also showed a survival advantage over the initial 2 years after surgery ( P = 0.04 ) and decreased episodes of recurrent ischemia ( 5 % versus 19 % ; P = 0.01 ) and developed fewer recurrent wound infections ( 1 % versus 10 % , P = 0.03 ) . Conclusions —Tight glycemic control with GIK  in diabetic CABG patients  improves perioperative outcomes , enhances survival , and decreases the incidence of ischemic events and wound complications BACKGROUND AND PURPOSE Hyperglycemia following acute stroke is strongly associated with subsequent mortality and impaired neurological recovery , but it is unknown whether maintenance of euglycemia in the acute phase improves prognosis . Furthermore , the safety of such intervention is not established . METHODS In an explanatory , r and omized , controlled trial to test safety , 53 acute ( within 24 hours of ictus ) stroke patients with mild to moderate hyperglycemia ( plasma glucose between 7.0 and 17.0 mmol/L ) were r and omized to receive either a 24-hour infusion of 0.9 % ( 154 mmol/L ) saline or a glucose potassium insulin ( GKI ) infusion at 100 mL/h . The GKI consisted of 16 U human soluble insulin and 20 mmol potassium chloride in 500 mL 10 % glucose . Blood glucose was measured every 2 hours with Boehringer Mannheim Glycaemie test strips , pulse and blood pressure were measured every 4 hours , and plasma glucose sample s were taken every 8 hours . Insulin concentration in the GKI was altered according to BM glucose values . RESULTS There were no statistically significant differences between the 2 groups at baseline . Twenty-five patients received GKI , 1 of whom required intravenous glucose for symptomatic hypoglycemia . Plasma glucose levels were nonsignificantly lower in the GKI group throughout the infusion period . Four-week mortality in the GKI group was 7 ( 28 % ) , compared with 8 ( 32 % ) in the control group . CONCLUSIONS GKI infusions can be safely administered to acute stroke patients with mild to moderate hyperglycemia producing a physiological but attenuated glucose response to acute stroke , the effectiveness of which remains to be eluci date BACKGROUND : Critically ill cardiothoracic patients are prone to hyperglycemia and an increased risk of surgical site infections postoperatively . Aggressive insulin treatment is required to achieve tight glycemic control ( TGC ) and improve outcomes . OBJECTIVE : To examine and report on the performance of an insulin infusion protocol to maintain TGC , defined as a blood glucose level of 80–150 mg/dL , in critically ill cardiothoracic surgical patients . METHODS : A nurse-driven insulin infusion protocol was developed and initiated in postoperative cardiothoracic surgical intensive care patients with or without diabetes . In this before — after cohort study , 2 periods of measurement were performed : a 6–month baseline period prior to the initiation of the insulin infusion protocol  ( control group , n = 174 ) followed by a 6–month intervention period in which the protocol was used ( TGC group , n = 168 ) . RESULTS : Findings showed percent and time of blood glucose measurements within the TGC range ( control 47 % vs TGC 61 % ; p = 0.001 ) , AUC of glucose exposure > 150 mg/dL versus time for the first 24 hours of the insulin infusion ( control 28.4 vs TGC 14.8 ; p < 0.001 ) , median time to blood glucose < 150 mg/dL ( control 9.4 h vs TGC 2.1 h ; p < 0.001 ) , and percent blood glucose < 65 mg/dL as a marker for hypoglycemia ( control 9.8 % vs TGC 16.7 % ; NS ) . CONCLUSIONS : An insulin infusion protocol design ed to achieve a goal blood glucose range of 80–150 mg/dL efficiently and significantly improved TGC in critically ill postoperative cardiothoracic surgery patients without significantly increasing the incidence of hypoglycemia Intensive insulin therapy to control blood glucose has been found to reduce mortality among critically ill patients in a surgical intensive care unit , though a simple prescriptive insulin infusion protocol to achieve this has not been published previously . This study documents the development and routine use of a simple prescriptive intravenous insulin infusion protocol for critically ill patients and compares the results with previous practice . During development the protocol was optimized and practical issues of implementation addressed . The optimized protocol was then used for all ICU admissions , and a prospect ively defined retrospective chart audit performed for the first month of use . Results were compared with a similar time period the previous year . In September 2002 , 27 admissions were started on the protocol .  Blood glucose for the time on the protocol had a median value of 6.2 ( IQR 5.9 - 7.1 ) mmol/l compared with 9.2 ( IQR 8.1 - 10.2 ) mmol/l for those on insulin in 2001 . Blood glucose for the whole ICU stay for those on the protocol in 2002 had a median value of 6.6 ( IQR 6.0 - 7.4 ) mmol/l compared with 8.6 ( IQR 8.0 - 9.4 ) mmol/l in 2001 . Blood glucose for all ICU patients in 2002 had a median value of 6.5 ( IQR 6.0 - 7.3 ) mmol/l compared with 7.2 ( IQR 6.3 - 8.3 ) mmol/l in 2001 . Three blood glucose recordings were less than 2.2 mmol/l in September 2002 . This study provides initial effectiveness and safety data for the Bath Insulin Protocol . Further audits in a larger patient population are now needed OBJECTIVE To describe the main findings of the Portl and Diabetic Project , which eluci date s the adverse relationship between hyperglycemia and outcomes of cardiac surgical procedures in patients with diabetes and delineates the protective effects of intravenous insulin therapy in reducing those adverse outcomes . RESULTS In this ongoing 17-year prospect i ve , nonr and omized , interventional study of 4,864 patients with diabetes who underwent an open-heart surgical procedure , we investigated the effects of hyperglycemia , and its subsequent reduction by continuous intravenous insulin ( CII ) therapy , on in-hospital outcomes . Increasing blood glucose levels were found to be directly associated with increasing rates of death , deep sternal wound infections ( DSWI ) , length of hospital stay ( LOS ) , and hospital cost . In separate multivariate analyses , increasing hyperglycemia was found to be independently predictive of increasing mortality ( P<0.0001 ) , DSWI ( P = 0.017 ) , and LOS ( P<0.002 ) . Conversely , CII therapy , design ed to achieve predetermined target blood glucose levels , independently reduced the risks of death and DSWI by 57 % and 66 % , respectively ( P<0.0001 for both ) . Target blood glucose levels of less than 150 mg/dL and a 3-day postoperative duration of CII therapy are both important variables that determine the effect of the CII therapy on improved outcomes . Coronary artery bypass grafting-related mortality ( 2.5 % ) and DSWI rates ( 0.8 % ) in patients with diabetes were normalized to those of the nondiabetic population by the use of the Portl and CII Protocol . CONCLUSION Perioperative hyperglycemia in patients undergoing a cardiac surgical procedure affects biochemical and physiologic functions , which , in turn , adversely alter mortality , LOS , and infection rates . The Portl and CII Protocol is a cost-efficient method that effectively eliminates hyperglycemia and reduces postoperative morbidity and mortality in patients with diabetes undergoing an open-heart operation . CII protocol s should be the st and ard care for glycometabolic control in all patients undergoing cardiac surgical procedures OBJECTIVES This study tested the impact of intensive metabolic treatment with insulin on transient myocardial ischaemia detected with continuous 12-lead ST-segment monitoring during non-ST segment elevation acute coronary syndromes in type 2 diabetic patients . METHODS AND RESULTS The study included 57 type 2 diabetic patients with non-ST segment elevation acute coronary syndromes . Twenty-eight patients r and omized to conventional treatment plus intensive insulin therapy ( group A ) and twenty-nine to conventional therapy only ( group B ) . Group A patients received insulin by infusion for 48 hours according to a predefined protocol aim ing to maintain normoglycaemia . Group B patients received st and ard coronary care unit treatment . The ST-segment monitoring was performed for 48 hours in the coronary care unit . The two groups were comparable in terms of medical history , clinical and biochemical data . Three patients from both groups were excluded from the analysis because there was objective evidence for evolution in persistent ST-segment elevation acute myocardial infa rct ion . Six patients ( 24 % ) from group A vs. twelve from group B ( 46.2 % ) had evidence of transient ischaemia ( p = 0.098 ) . Group A patients showed significantly lower values in the mean number [ group A vs. group B : 0.4 + /- 0.8 vs. 2 + /- 3.1 , p < 0.01 ] and total duration of ST-episodes [ group A vs. group B : 2.4 + /- 5.1 vs. 21.2 + /- 31 min , p < 0.01 ] . Multivariate analysis revealed that the mean plasma glucose during the study period was a powerful predictor of the presence ( b:0.377,p < 0.01 ) , the number ( b:0.523,p < 0.001 ) and the total duration ( b : 0.686 , p < 0.001 ) of ST-episodes , respectively . CONCLUSIONS ; Intensive insulin treatment considerably decreases the number and the total duration of ST-episodes in type 2 
    Output:
    
ConclusionS tudies using a dynamic scale protocol combining a tight glucose target and the last two blood glucose values to determine the insulin infusion rate yielded the best results in terms of glycaemic control and reported low frequencies of hypoglycaemic episodes