Glucose control in pediatric intensive care unit patients using an insulin-glucose algorithm

Area of Science:

• Pediatric critical care medicine
• Endocrinology
• Biomedical engineering

Background:

• Hyperglycemia in intensive care units (ICUs) is linked to increased morbidity and mortality.
• Existing algorithms for glycemic control in ICUs are continually advancing.
• This study assesses a discrete proportional-integral-derivative (PID) algorithm for hyperglycemia management in pediatric ICU (PICU) patients.

Purpose of the Study:

• To evaluate the efficacy and safety of a discrete PID algorithm for controlling hyperglycemia in a PICU setting.
• To assess the algorithm's performance in pediatric patients with diverse conditions, including diabetic ketoacidosis and glucocorticoid-induced hyperglycemia.
• To determine the algorithm's ability to maintain target glucose levels despite clinical complexities.

Main Methods:

• Six PICU patients (four with diabetic ketoacidosis, two with glucocorticoid-induced hyperglycemia) with glucose >150 mg/dL were enrolled.
• A PID algorithm provided recommendations for intravenous insulin infusion rate adjustments and next glucose measurement timing.
• Glucose targets were dynamically adjusted based on individual patient clinical status.

Main Results:

• The algorithm was used for 454.4 hours in patients aged 1.8-14 years.
• Five of six patients reached their initial glucose target, with a mean time of 8.7 hours.
• Post-target achievement, mean glucose standard deviation was 23.5 mg/dL, with minimal deviations outside the target range and no hypoglycemia (glucose <55 mg/dL).

Conclusions:

• The discrete PID algorithm demonstrated safe and effective hyperglycemia control in a PICU environment.
• The algorithm maintained glycemic control despite frequent clinical interventions such as fluid changes, high-dose steroids, and hemodialysis.
• This suggests the PID algorithm is a viable tool for managing complex hyperglycemia in critically ill children.