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A protocolized approach to identify and manage hyperglycemia in a pediatric critical care unit

Catherine M Preissig1, Inger Hansen, Pei-Ling Roerig

  • 1Department of Pediatrics, Division of Pediatric Critical Care Medicine, Emory University School of Medicine, Atlanta, GA, USA.

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|October 8, 2008
PubMed

Insights

Hyperglycemia is common in pediatric intensive care units. A new protocol effectively identifies and manages high blood glucose in critically ill children, improving outcomes.

Area of Science:

  • Pediatric Critical Care Medicine
  • Endocrinology
  • Clinical Management

Background:

  • Hyperglycemia is a known risk factor for adverse outcomes in critically ill adults.
  • Limited data exists on hyperglycemia prevalence and management in pediatric intensive care units (PICUs).

Purpose of the Study:

  • To determine the prevalence and risk factors of hyperglycemia in critically ill children.
  • To evaluate the effectiveness of a pediatric-specific protocol for glycemic control.

Main Methods:

  • A protocol was developed for identifying and managing hyperglycemia in PICU patients (>6 months, >5 kg, excluding end-stage liver disease/type 1 diabetes).
  • Hyperglycemia was defined as two consecutive blood glucose readings >140 mg/dL.
  • Insulin infusion was used to maintain blood glucose levels between 80-140 mg/dL.

Main Results:

  • Hyperglycemia prevalence was 20% (74 of 477 patients).
  • Associated factors included mechanical ventilation, vasopressor/inotrope infusions, continuous renal replacement therapy, high illness severity, and longer hospital stays.
  • The protocol achieved target blood glucose levels (<160 mg/dL) on 70% of insulin-treated days and 80-140 mg/dL on 49% of days.

Conclusions:

  • Hyperglycemia is prevalent in PICUs.
  • A protocolized approach can effectively identify and manage hyperglycemia in critically ill children.
Abstract

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