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Glucose control in severely thermally injured pediatric patients: what glucose range should be the target?

Marc G Jeschke1, Robert Kraft, Fatemeh Emdad

  • 1Shriners Hospitals for Children, Biochemistry and Molecular Biology, Galveston, TX, USA. majeschk@utmb.edu

Annals of Surgery
|August 27, 2010
PubMed

Insights

Targeting a blood glucose level of 130 mg/dL in severely burned pediatric patients is associated with improved outcomes. This glucose range reduces infections, sepsis, and mortality, while attenuating inflammatory responses.

Area of Science:

  • Critical care medicine
  • Pediatric burn management
  • Metabolic control in trauma

Background:

  • Tight glycemic control in intensive care units has shown detrimental outcomes.
  • Evidence suggests current tight euglycemic control protocols may be harmful.
  • No established glucose range is currently recommended for thermally injured patients.

Purpose of the Study:

  • To identify optimal blood glucose levels for improved outcomes in severely burned pediatric patients.
  • To evaluate the association between specific glucose ranges and patient morbidity and mortality.
  • To guide glucose management strategies in critical burn care.

Main Methods:

  • A cohort of 208 severely burned pediatric patients (burns >30% TBSA) was analyzed.
  • Statistical models determined daily average and 6 AM glucose targets linked to outcomes.
  • Patients were stratified into good vs. poor glucose control groups for comparative analysis.

Main Results:

  • Hyperglycemia strongly predicts adverse hospital outcomes.
  • A daily 6 AM glucose level of 130 mg/dL and a daily average of 140 mg/dL correlate with better outcomes.
  • Patients with glucose levels around 130 mg/dL exhibited reduced inflammation, infection, sepsis, and mortality.

Conclusions:

  • A target blood glucose level of 130 mg/dL is suggested for severely burned patients.
  • This target range may mitigate risks associated with hypoglycemia and improve survival.
  • Optimizing glucose control is crucial for managing hypermetabolic and inflammatory responses post-burn.
Abstract

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