A disparity between physician attitudes and practice regarding hyperglycemia in pediatric intensive care units in the United States: a survey on actual practice habits

Preissig, Catherine; Rigby, Mark R.

doi:10.1186/cc8865

Cited by 38 publications

(31 citation statements)

References 26 publications

(37 reference statements)

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“…7 Hence most of the pediatric critical care physicians would care to avoid stress hyperglycemia but worry about the hypoglycemia encountered while attempting for a tight glycemic control. 10,11 Mechanical ventilation, vasoactive infusions, renal replacement therapies, cardiopulmonary bypass and extracorporeal life support, therapeutic hypothermia, prolonged immobility, nutrition support practices, and the use of medications are all known to mediate development of SH in critical illness. 12 In this study 58 % were females and 42% were males.…”

Section: Discussionmentioning

confidence: 99%

Stress hyperglycemia: clinical profile and outcome in critically ill children

Grace¹,

Varadarajan

2017

Int J Contemp Pediatr

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INTRODUCTIONStress hyperglycemia(SH) occurs commonly during critical illness in children with previously normal glucose homeostasis. [1][2][3][4] It is often discovered incidentally when routine blood sugar measurements reveal an elevated blood glucose. It is estimated that 49-70% of children with stress hyperglycemia have BG concentrates >150 mg/dl, 20-35% of children have BG > 200 mg/dl. 1-4However the occurrence of blood glucose more than 150 ABSTRACT Background: Stress hyperglycemia (SH) occurs commonly during critical illness in children with previously normal glucose homeostasis. Objective of present study was to study the clinical presentation, underlying illness and the outcome of stress hyperglycemia among critically ill children. Methods: Children attending the outpatient department and the casualty were admitted to Emergency department based on the triage guidelines. Children with blood glucose above 200 mg/dl on admission to the emergency department were considered to have hyperglycemia and were shifted to the Paediatric intensive care unit or the paediatric wards for further management. Data was collected as per the proforma. The blood sugar values were followed up in these children until restoration of normoglycemia. All the children were followed up till discharge or death in case of mortality. Associated risk factors were analysed between the survivors and nonsurvivors. Results: Among 102 children included in the study group from1 month to 12 yrs, 55 were infants, 37 in the age group of 1-5 yrs and 10 were more than 5 yrs. 60 were males and 42 were females. Family history of diabetes was encountered in 10 children. Out of 102 children, 60 recovered to hospital discharge. Sepsis, seizures, bronchopneumonia and CNS infections were the common illness among children with stress hyperglycemia. Age less than 1year, breathlessness, fever, shock, seizures and altered sensorium were identified to be significantly associated with mortality in children with stress hyperglycemia by univariate analysis in this study. Regression analysis revealed age less than one year, presence of lung infiltrates, longer duration of hyperglycemia, and need for Paediatric Intensive Care Unit (PICU) admission to be significantly associated with mortality. Non survivors had persistent hyperglycemia up to 48 hours in comparison to survivors. Overall mortality in the study group was 41%. Conclusions: Incidence of stress hyperglycemia is high in infants. Infections were the common underlying diagnosis in stress hyperglycemia. Being an infant, prolonged hyperglycemia for 48 hrs and need for PICU care were significantly associated with mortality. Overall mortality in children with stress hyperglycemia is 41%.

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Section: Discussionmentioning

confidence: 99%

Stress hyperglycemia: clinical profile and outcome in critically ill children

Grace¹,

Varadarajan

2017

Int J Contemp Pediatr

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“…Surveys have shown that there is wide variation in physicians' beliefs and practices with respect to BG control in critically ill children. 22,29,30 This probably represents the current usual practice of glucose control in critically ill children with variations of protocols used and BG measurements from different blood compartments using BG meters. 12,13 The present study included patients from two ICUs with a broad mix of diagnoses.…”

Section: Discussionmentioning

confidence: 99%

Retrospective Outcomes of Glucose Control in Critically Ill Children

Kandil

Spear

Thomas

et al. 2013

J Diabetes Sci Technol

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Background: Hyperglycemia is a significant problem for critically ill children. Treatment for hyperglycemia remains controversial. This study explores the effect of controlling blood glucose (BG) in hyperglycemic critically ill children. Methods: A retrospective cohort of nondiabetic critically ill children (defined as requiring mechanical ventilation and/or vasopressors) with BG persistently ≥150 mg/dl and treated with insulin (treatment group) were compared with a historical cohort of similar children who did not receive interventions to control hyperglycemia (baseline group). Results: There were 130 children in the treatment group and 137 children in the baseline group. Mean BG in the treatment group was 140 ± 24 mg/dl compared with 179 ± 47 mg/dl in the baseline group (p < .001). After adjusting for patient characteristics, cointerventions, and glucose metrics, patients in the treatment group had 2.5 fewer intensive care unit (ICU)-free days (i.e., number of days alive and discharged from ICU within 28 days after inclusion) than the baseline group (p = .023). Glucose control was not independently associated with duration of ICU stay, ventilator-free days, vasopressor-free days, or mortality. Conclusions: Blood glucose control appears associated with worse outcomes in critically ill children. Our data combined with conflicting results in adults leads us to strongly advocate for the conduct of randomized trials on glucose control in critically ill children.

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“…[43][44][45] It is unclear as to what extent these recommendations have been adopted by pediatric intensivists. 46,47 By stratifying glucose data according to the number of glucose values above each cutoff, the prevalence of hypo-and hyperglycemia was identified more accurately and the influence of spurious "one-time" glucose measurements was removed. Similar to previous reports, increasing glucose values were associated with increasing total hospital and PICU LOS with the greatest LOS reported in patients above the 200 mg/dl cutoff.…”

Section: Discussionmentioning

confidence: 99%

Association of Hyperglycemia, Glucocorticoids, and Insulin Use with Morbidity and Mortality in the Pediatric Intensive Care Unit

Wintergerst

Foster

Sullivan

et al. 2012

J Diabetes Sci Technol

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Background: Studies of pediatric intensive care unit (PICU) patients have shown a significant association of morbidity and mortality with hyperglycemia. We retrospectively evaluated the degree of hyperglycemia as well as its correlation with glucocorticoid and insulin use and assessed its association with hospital length of stay (LOS) and mortality. This study preceded the initiation of a standard glycemic control protocol. Methods: We examined medical records at Kosair Children's Hospital for all PICU admissions from 2008 of patients without diabetes mellitus. Critical illness hyperglycemia (CIH) was defined by having three or more peak glucose values greater than thresholds of 110, 140, 180, and 200 mg/dl. These patients were evaluated for glucocorticoid, insulin use, and outcome measures. Results: We evaluated the eligible 1173 admissions, where 10.5% of these patients reached the highest threshold (200 mg/dl) of CIH. Glucocorticoids were used in 43% of these patients, with dexamethasone being the most common (58%). There was a significant correlation between glucocorticoids and higher peak glucose values, where 81% of the patients who were above the 200 mg/dl cutoff level were treated with glucocorticoids. Only 36.8% in that group were also treated with insulin. Patients at the 200 mg/dl cutoff had the highest median PICU and total hospital length of stays (4 and 10 days, respectfully). Mortality was associated with increasing glucose levels, reaching 18.7% among patients above the 200 mg/dl cutoff. Conclusion: Hyperglycemia was prevalent in the PICU and was associated with increased morbidity, as characterized by increased LOS and increased mortality. Glucocorticoid use was prevalent among patients exhibiting hyperglycemia. Insulin use was uncommon.

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A disparity between physician attitudes and practice regarding hyperglycemia in pediatric intensive care units in the United States: a survey on actual practice habits

Cited by 38 publications

References 26 publications

Stress hyperglycemia: clinical profile and outcome in critically ill children

Stress hyperglycemia: clinical profile and outcome in critically ill children

Retrospective Outcomes of Glucose Control in Critically Ill Children

Association of Hyperglycemia, Glucocorticoids, and Insulin Use with Morbidity and Mortality in the Pediatric Intensive Care Unit

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