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Tight glycemic control in critically ill pediatric patients: a meta-analysis and systematic review of randomized

Yiyang Zhao1, Yang Wu1, Bo Xiang1

  • 1Department of Pediatric Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, China.

Pediatric Research
|December 16, 2017
PubMed

Insights

Tight glycemic control (TGC) in pediatric intensive care units (PICUs) does not lower mortality or infections in critically ill children. However, TGC significantly increases hypoglycemia risk compared to conventional glycemic control (CGC).

Area of Science:

  • Pediatric Critical Care Medicine
  • Endocrinology
  • Clinical Research Methodology

Background:

  • Controversies persist regarding the impact of tight glycemic control (TGC) in critically ill children.
  • Understanding the risks and benefits of TGC versus conventional glycemic control (CGC) is crucial for pediatric intensive care unit (PICU) management.

Purpose of the Study:

  • To evaluate the benefits and risks of TGC compared to CGC in critically ill pediatric patients.
  • To synthesize evidence from randomized controlled trials (RCTs) on glycemic control strategies in the PICU.

Main Methods:

  • Systematic literature search of EMBASE, CNKI, PubMed, and Cochrane Database for relevant RCTs.
  • Meta-analysis of 5 RCTs involving 3,933 critically ill children comparing TGC and CGC.
  • Statistical analysis of mortality rates, healthcare-associated infections, and hypoglycemia incidence.

Main Results:

  • TGC did not significantly reduce 30-day mortality rates compared to CGC (OR 0.99, 95% CI 0.74-1.32, P=0.95).
  • TGC was not associated with a decrease in healthcare-associated infections (OR 0.80, 95% CI 0.64-1.00, P=0.05).
  • TGC significantly increased the incidence of hypoglycemia (OR 6.37, 95% CI 4.41-9.21, P<0.001).

Conclusions:

  • TGC in critically ill children does not offer benefits in reducing 30-day mortality or acquired infections compared to CGC.
  • A significant increase in hypoglycemia incidence is a major risk associated with TGC in this population.
  • Methodological heterogeneity across trials necessitates cautious interpretation of these findings.

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