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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 Xiang2

  • 1Department of Pediatric Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, People's Republic of China.

Pediatric Research
|May 26, 2018
PubMed

Insights

Tight glycemic control (TGC) in critically ill children does not lower mortality or infection rates. However, TGC significantly increases the risk of hypoglycemia, a serious complication requiring careful consideration in pediatric intensive care units (PICUs).

Area of Science:

  • Pediatric Critical Care Medicine
  • Endocrinology
  • Clinical Research Methodology

Background:

  • Controversies exist regarding the impact of tight glycemic control (TGC) in critically ill children.
  • Pediatric intensive care units (PICUs) face challenges in optimizing glucose management for critically ill youth.

Purpose of the Study:

  • To assess the benefits and risks of tight glycemic control (TGC) versus conventional glycemic control (CGC).
  • To evaluate TGC's effect on mortality, infections, and hypoglycemia in critically ill children using randomized controlled trial (RCT) data.

Main Methods:

  • A meta-analysis was conducted using data from five randomized controlled trials (RCTs).
  • Searched databases included EMBASE, CNKI, PubMed, and the Cochrane Database for relevant RCTs.
  • Included 3933 critically ill pediatric patients admitted to the PICU.

Main Results:

  • Tight glycemic control (TGC) did not significantly reduce 30-day mortality rates compared to conventional glycemic control (CGC).
  • TGC was not associated with a decrease in health care-associated infections.
  • TGC significantly increased the incidence of hypoglycemia (OR 6.37, 95% CI 4.41-9.21, P < 0.001).

Conclusions:

  • Tight glycemic control (TGC) offers no significant benefit in reducing mortality or acquired infections in critically ill children.
  • A notable increase in hypoglycemia incidence was observed in the TGC group.
  • Methodological heterogeneity across trials necessitates cautious interpretation of these findings.
Abstract

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