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Published on: June 11, 2012

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

Kupper A Wintergerst1, Dorothee Deiss, Bruce Buckingham

  • 1Pediatric Endocrinology, Kosair Children's Hospital, University of Louisville, Louisville, Kentucky 40202, USA. kawint01@louisville.edu

Diabetes Technology & Therapeutics
|June 15, 2007
PubMed

Insights

A proportional-integral-derivative (PID) algorithm effectively managed hyperglycemia in a pediatric intensive care unit (PICU). This advanced glycemic control method proved safe for critically ill children, including those with diabetic ketoacidosis.

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.
Abstract

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