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Stress hyperglycemia in pediatric critical illness: the intensive care unit adds to the stress!

Vijay Srinivasan1

  • 1Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA. srinivasan@email.chop.edu

Journal of Diabetes Science and Technology
|March 10, 2012
PubMed

Insights

Stress hyperglycemia (SH) in critically ill children is linked to worse outcomes, challenging older views. Intensive care unit (ICU) practices significantly impact SH, necessitating standardized protocols for future research on tight glucose control (TGC).

Area of Science:

  • Pediatric critical care medicine
  • Endocrinology
  • Metabolic disorders

Background:

  • Stress hyperglycemia (SH) is prevalent in critically ill children.
  • Emerging evidence links SH to adverse outcomes, contradicting historical beliefs.
  • SH development is influenced by intrinsic metabolic changes and extrinsic intensive care unit (ICU) practices.

Purpose of the Study:

  • To review the impact of ICU practices on SH in critically ill children.
  • To discuss the implications of SH for patient outcomes.
  • To highlight the need for standardized protocols in tight glucose control (TGC) research.

Main Methods:

  • Literature review of studies on SH in pediatric critical illness.
  • Analysis of factors contributing to SH development in the ICU.
  • Examination of the role of ICU interventions in SH pathogenesis.

Main Results:

  • Numerous ICU practices, including mechanical ventilation and vasoactive infusions, are associated with SH.
  • The effectiveness of tight glucose control (TGC) in adults has yielded inconclusive results, potentially due to practice variations.
  • SH is increasingly recognized as a marker of severity and predictor of poor prognosis in pediatric critical illness.

Conclusions:

  • ICU interventions play a significant role in the development of SH during critical illness.
  • Standardization of ICU practices and TGC protocols is crucial for future research to yield reliable conclusions.
  • Further investigation is needed to optimize SH management and improve outcomes in pediatric critical care.

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