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Short-Term Adverse Outcomes Associated With Hypoglycemia in Critically Ill Children

Edward Vincent S Faustino1, Eliotte L Hirshberg2, Lisa A Asaro3

  • 1Department of Pediatrics, Yale School of Medicine, New Haven, CT.

Critical Care Medicine
|February 22, 2019
PubMed

Insights

Hypoglycemia in critically ill children, even when mild, is linked to worse short-term outcomes like fewer ICU-free days. Advanced monitoring and algorithms reduced severe hypoglycemia but not its association with adverse events.

Area of Science:

  • Pediatric Critical Care Medicine
  • Endocrinology
  • Clinical Research

Background:

  • Previous studies indicated worse outcomes with hypoglycemia in critically ill children, but relied on intermittent glucose monitoring, potentially causing detection bias.
  • Critically ill children with cardiovascular and/or respiratory failure often experience hyperglycemia, requiring careful glucose management.

Purpose of the Study:

  • To determine the association between hypoglycemia and adverse short-term outcomes in critically ill children.
  • To evaluate the effectiveness of advanced glucose monitoring and management strategies in preventing hypoglycemia.

Main Methods:

  • A nested case-control study was conducted using data from the Heart And Lung Failure-Pediatric INsulin Titration trial.
  • Thirty-five pediatric intensive care units (PICUs) utilized a computerized algorithm, continuous glucose monitors, and standardized glucose infusion rates to manage hyperglycemia and minimize hypoglycemia.
  • Cases were defined as children with any hypoglycemia (blood glucose < 60 mg/dL), matched with controls without hypoglycemia based on age, study day, and illness severity.

Main Results:

  • Any hypoglycemia (blood glucose < 60 mg/dL) occurred in 16.0% of children, with severe hypoglycemia (< 40 mg/dL) in 3.6%.
  • Hypoglycemia was associated with significantly fewer ICU-free days (15.3 vs. 20.2 days) and hospital-free days (0 vs. 7 days) through day 28.
  • Mortality and ventilator-free days did not differ between groups; however, insulin-induced hypoglycemia was linked to more instances of zero ICU-free days.

Conclusions:

  • Despite advanced glucose management strategies, hypoglycemia remains common in critically ill children and is associated with worse short-term outcomes.
  • Severe hypoglycemia was uncommon, but any degree of hypoglycemia negatively impacted recovery metrics.
  • The findings highlight the need for continued vigilance in glucose control to mitigate adverse outcomes in this vulnerable population.
Abstract

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