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Published on: June 11, 2012
Intensive insulin therapy for patients in paediatric intensive care: a prospective, randomised controlled study
Dirk Vlasselaers1, Ilse Milants, Lars Desmet
1Department of Intensive Care Medicine (Paediatric Intensive Care Unit), Catholic University Leuven, Leuven, Belgium.
Insights
Targeting normal blood glucose levels in critically ill infants and children using insulin infusion significantly reduced intensive care unit stays and mortality. This intervention improved short-term outcomes, but long-term effects require further study.
Area of Science:
- Pediatric Critical Care Medicine
- Endocrinology
- Clinical Research
Background:
- Critically ill infants and children frequently experience hyperglycemia, which is linked to poor outcomes.
- The efficacy of normalizing blood glucose to age-adjusted fasting levels in this population remains uncertain.
Purpose of the Study:
- To investigate the impact of targeting age-adjusted normoglycemia via insulin infusion on the outcomes of critically ill infants and children.
Main Methods:
- A prospective, randomized controlled study involved 700 critically ill patients (317 infants, 383 children) in a pediatric intensive care unit (PICU).
- Patients were randomized to either intensive insulin infusion targeting specific glucose ranges or conventional insulin infusion to prevent levels exceeding 11.9 mmol/L.
- Primary endpoints included PICU length of stay and inflammatory markers; analysis was intention-to-treat.
Main Results:
- The intensive group achieved significantly lower mean blood glucose concentrations compared to the conventional group (p<0.0001).
- While hypoglycemia occurred more frequently in the intensive group (25% vs 1%), the duration of PICU stay was shorter (p=0.017).
- The intensive group showed reduced mortality (3% vs 6%, p=0.038) and a lower proportion of patients with extended PICU stays (38% vs 47%, p=0.013).
Conclusions:
- Targeting age-adjusted normal blood glucose concentrations with insulin infusion improved short-term outcomes in critically ill pediatric patients.
- Further research is necessary to evaluate the long-term survival, morbidity, and neurocognitive development in this cohort.
Background:
Critically ill infants and children often develop hyperglycaemia, which is associated with adverse outcome; however, whether lowering blood glucose concentrations to age-adjusted normal fasting values improves outcome is unknown. We investigated the effect of targeting age-adjusted normoglycaemia with insulin infusion in critically ill infants and children on outcome.
Methods:
In a prospective, randomised controlled study, we enrolled 700 critically ill patients, 317 infants (aged <1 year) and 383 children (aged >or=1 year), who were admitted to the paediatric intensive care unit (PICU) of the University Hospital of Leuven, Belgium. Patients were randomly assigned by blinded envelopes to target blood glucose concentrations of 2.8-4.4 mmol/L in infants and 3.9-5.6 mmol/L in children with insulin infusion throughout PICU stay (intensive group [n=349]), or to insulin infusion only to prevent blood glucose from exceeding 11.9 mmol/L (conventional group [n=351]). Patients and laboratory staff were blinded to treatment allocation. Primary endpoints were duration of PICU stay and inflammation. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00214916.
Findings:
Mean blood glucose concentrations were lower in the intensive group than in the conventional group (infants: 4.8 [SD 1.2] mmol/L vs 6.4 [1.2] mmol/L, p<0.0001; children: 5.3 [1.1] mmol/L vs 8.2 [3.3] mmol/L, p<0.0001). Hypoglycaemia (defined as blood glucose
Interpretation:
Targeting of blood glucose concentrations to age-adjusted normal fasting concentrations improved short-term outcome of patients in PICU. The effect on long-term survival, morbidity, and neurocognitive development needs to be investigated.
Funding:
Research Foundation (Belgium); Research Fund of the University of Leuven (Belgium) and the EU Information Society Technologies Integrated project "CLINICIP"; and Institute for Science and Technology (Belgium).
