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Published on: June 11, 2012
Management of hyperglycemia in the pediatric intensive care unit; implementation of a glucose control protocol
Jennifer J Verhoeven1, Jeannette B Brand, Mirjam M van de Polder
1Intensive Care, Erasmus MC-Sophia Children's Hospital Rotterdam, Rotterdam, The Netherlands.
Insights
A nurse-driven protocol effectively managed hyperglycemia in critically ill children, achieving normal blood glucose levels in 94% within 12 hours without severe hypoglycemia. This glucose control strategy shows promise for pediatric intensive care units.
Area of Science:
- Pediatric Critical Care Medicine
- Endocrinology
- Nursing Practice
Background:
- Hyperglycemia is common in critically ill children and associated with adverse outcomes.
- Effective glucose control is crucial for improving patient outcomes in pediatric intensive care units (PICUs).
- Existing protocols may require refinement for optimal implementation in pediatric populations.
Purpose of the Study:
- To evaluate the efficacy and safety of a stepwise nurse-driven glucose control protocol.
- To assess the time to achieve normoglycemia in critically ill pediatric patients with hyperglycemia.
- To determine the incidence of severe hypoglycemia during protocol implementation.
Main Methods:
- Prospective observational study conducted in an academic pediatric intensive care unit.
- Inclusion of 50 consecutively admitted critically ill children with hyperglycemia (>8 mmol/L).
- Treatment administered according to a stepwise nurse-driven glucose control protocol.
Main Results:
- The protocol achieved normoglycemia (<8 mmol/L) in 94% (47/50) of children within a median of 5 hours after insulin initiation.
- Insulin therapy was initiated at a median blood glucose of 11.4 mmol/L, 4 hours after documented hyperglycemia.
- No episodes of severe hypoglycemia (<2.2 mmol/L) were observed during the study period.
Conclusions:
- The nurse-driven glucose control protocol is effective in normalizing blood glucose levels in critically ill children.
- The protocol demonstrated a favorable safety profile, with no severe hypoglycemia events.
- Further research is warranted to confirm safety and facilitate broader implementation in PICUs.
Objective:
To evaluate a stepwise nurse-driven glucose control protocol for the treatment of hyperglycemia in critically ill pediatric patients.
Setting:
Academic pediatric intensive care unit.
Design:
Prospective observational study.
Patients:
A total of 50 consecutively admitted critically ill children with hyperglycemia >8 mmol/L (>145 mg/dL) were included and treated according to the glucose control protocol.
Measurements And Main Results:
Demographic data and clinical parameters were collected and different steps in the protocol were evaluated. Data were expressed as medians with interquartile ranges. Fifty children (28 boys), aged 3.5 yrs (range, 1.2 -9.3 yrs) were treated in 18 mos. Forty-two children had multiple organ failure. Eight children died. Insulin treatment was initiated 4 hrs after the first episode of hyperglycemia was documented (median blood glucose, 11.4 mmol/L, [207 mg/dL] [9.7-14.5 mmol/L, 176-264 mg/dL]). Blood glucose was <8 mmol/L (<145 mg/dL) within 12 hrs of initiating insulin therapy in 47 (94%) of 50 children (median, 5 hrs). Duration of treatment was 34 hrs (17-72 hrs) and the maximum insulin dose ranged between 20 and 200 mIU/kg/hr (median, 70 mIU/kg/hr). Episodes of severe hypoglycemia <2.2 mmol/L (<47 mg/dL) did not occur.
Conclusion:
The use of a stepwise nurse-driven glucose control protocol resulted in normoglycemia within 12 hrs for 94% of the children involved. Episodes of severe hypoglycemia did not occur. We conclude that the glucose control protocol is effective in treating hyperglycemia in critically ill children. Further studies are necessary to assess safety before the protocol could also be implemented in other pediatric intensive care units.
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