Hyperglycemia and insulin therapy in the critically ill child*

Abstract

This survey suggests significant variation in the management of hyperglycemia across the UK Practice varies even among intensivists from the same unit, reflecting the fact that few units have 'an agreed written guidance in place.' The majority of intensivists would be prepared to participate in a trial of tight glycemic control.

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

“…Similar to findings by others, we report that most pediatric ICU practitioners (60%) believe that hypo glycemia is more dangerous than hyper glycemia in critically ill children [24,25]. Although there are reports of immediate and long-term sequela from hypoglycemic episodes in children, the direct relationship of the severity and duration of hypoglycemia to adverse effects is unclear.…”

“…Despite recent debate regarding outcome improvements in adults and goal target glycemic ranges, numerous medical advisory groups recommend routine glycemic control as standard care in adult ICUs [19-22]. Because previous studies suggest most pediatric intensivists believe hyperglycemia may be hazardous to their patients, readers may infer that as in adult ICUs, glycemic control measures are the norm in pediatric ICU practice [24,25]. To ascertain the true practice patterns regarding glycemic control in critically ill children, we assessed beliefs and actual practice habits in a spectrum of pediatric ICUs in the United States.…”

“…We find that beliefs and practice habits vary greatly between different centers, and even among practitioners from the same center. Recently a study from the United Kingdom also reported a wide variation of beliefs regarding glycemic control when respondents were queried about potential clinical scenarios [25]. …”

“…Recent studies indicate that hyperglycemia is a significant concern among physicians caring for critically ill children and suggest that glycemic management is routinely performed [24,25]. Our group developed and published a protocol to identify and manage hyperglycemia in critically ill children and adopted this practice as routine care in our pediatric intensive care unit (ICU) [11,13].…”

Treating hyperglycemia in the critically ill child: Is there enough evidence?

“…A survey among the pediatric intensivists in the UK [29], and a pros-pective study from the PICUs of Australia and New Zealand [30] showed neither uniform glucose con-trol regimes nor consensus regarding levels of hyper-glycemia requiring therapy.…”