Insulin therapy in hyperglycemic children with severe acute asthma

Area of Science:

• Pediatric Critical Care Medicine
• Pediatric Pulmonology
• Pediatric Endocrinology

Background:

• Severe acute asthma (SAA) in children can be complicated by hyperglycemia.
• Hyperglycemia management in SAA is challenging, with limited evidence on interventions.
• Intravenous (IV) insulin is a potential treatment for hyperglycemia in this population.

Purpose of the Study:

• To evaluate the impact of IV insulin on IV salbutamol consumption and length of stay (LOS) in pediatric intensive care units (PICUs).
• To assess the efficacy of an insulin protocol for managing hyperglycemia in children with SAA.

Main Methods:

• Retrospective, descriptive study analyzing clinical data from 1994-2010.
• Comparison of patient outcomes before and after the implementation of an insulin protocol for hyperglycemia (blood glucose >8 mmol/L).
• Inclusion of 131 pediatric patients with SAA, hyperglycemia, and requiring IV salbutamol.

Main Results:

• No significant difference in illness severity between insulin-treated and non-treated groups.
• Insulin-treated patients showed higher maximum blood glucose levels and cumulative IV salbutamol doses.
• No significant differences observed in the duration of IV salbutamol administration or LOS.

Conclusions:

• The implemented insulin protocol did not demonstrate significant improvements in clinical outcomes for pediatric SAA with hyperglycemia.
• The labor-intensive nature of the protocol, coupled with a lack of outcome benefit, raises questions about its efficacy.
• Further research may be needed to determine optimal hyperglycemia management strategies in pediatric SAA.