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Control of serum glucose concentration in critical illness

Sarah B Kandil1, Michael Miksa, E Vincent S Faustino

  • 1Department of Pediatrics, Section of Pediatric Critical Care Medicine, Yale University School of Medicine, New Haven, Connecticut 06520-8064, USA. sarah.kandil@yale.edu

Current Opinion in Pediatrics
|May 10, 2013
PubMed

Insights

Tight glycemic control (TGC) in pediatric intensive care units (ICUs) is feasible and safe, but its clinical benefits for children remain uncertain. Further research is needed to clarify the advantages of managing blood sugar levels in critically ill children.

Area of Science:

  • Pediatric critical care medicine
  • Endocrinology
  • Intensive care management

Background:

  • Hyperglycemia poses a significant challenge in pediatric intensive care units (ICUs).
  • Tight glycemic control (TGC) is a controversial method for managing hyperglycemia due to potential hypoglycemia risks.
  • Evidence on TGC in critically ill children is limited and evolving.

Purpose of the Study:

  • To review the latest evidence on the use of tight glycemic control (TGC) in critically ill children.
  • To assess the safety and efficacy of TGC in pediatric intensive care settings.
  • To address the ongoing controversy surrounding TGC for hyperglycemia management in pediatric patients.

Main Methods:

  • Review of recent randomized controlled trials (RCTs) and published studies.
  • Analysis of data from pediatric intensive care populations, including postoperative cardiac surgery patients.
  • Evaluation of long-term safety data regarding hypoglycemia in children undergoing TGC.

Main Results:

  • Two RCTs showed TGC is feasible and safe in pediatric patients, primarily those post-cardiac surgery.
  • These trials yielded conflicting results regarding the benefits of TGC.
  • Uncertainty exists regarding the generalizability of findings to non-cardiac surgical patients.
  • Long-term safety studies indicate hypoglycemia during TGC was not linked to neurocognitive deficits in children, unlike in adults.

Conclusions:

  • Tight glycemic control (TGC) can be safely implemented in critically ill children.
  • The overall clinical benefit of TGC in this population remains unclear.
  • Further investigation is warranted to establish the definitive efficacy of TGC in pediatric critical care.
Abstract

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