Treating hyperglycemia in the critically ill child: Is there enough evidence?
- Banani Poddar
- … show all 1 hide
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Need and purpose of review
Hyperglycemia is prevalent among critically ill pediatric patients. Previously thought to be an adaptive response to stress, hyperglycemia is now recognized to be associated with an adverse outcome. Correction of such hyperglycemia with insulin infusion has been shown to improve outcome but carries risk of hypoglycemia. This review addresses these issues related to treatment of hyperglycemia.
A Pubmed search was performed using the search strategy: (hyperglycemia OR blood glucose OR insulin therapy) AND (critical illness OR critical care OR intensive care unit). Randomized controlled trials, clinical trials, meta-analysis and observational studies (adult and pediatric) published in the last 10 years were included.
Blood sugar monitoring and correction of hyperglycemia while caring for critically ill children is crucial. A modest blood glucose target of <150 mg/dL is appropriate. Providing adequate nutrition along with training of the nursing personnel would prevent any adverse effect such as hypoglycemia.
- Corstjens AM, Van der Horst ICC, Zijlstra JG, Johan Groeneveld AB, Zijlstra F, Tulleken JE, et al. Hyperglycemia in critically ill patients: marker or mediator of mortality? Crit Care. 2006;10:216. CrossRef
- Marik PE, Raghavan M. Stress-hyperglycemia, insulin and immunomodulation in sepsis. Intensive Care Med. 2004;30:748–756. CrossRef
- Derde S, Vanhorebeek I, Van den Berghe G. Insulin treatment in intensive care patients. Horm Res. 2009;71:2–11. CrossRef
- Capes SE, Hunt D, Malmberg K, Gerstein HC. Stress hyperglycemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview. Lancet. 2000;355:773–778. CrossRef
- Capes SE, Hunt D, Malmberg K, Pathak P, Gerstein HC. Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients: a systematic overview. Stroke. 2001;32:2426–2432. CrossRef
- Sung J, Bochicchio GV, Joshi M, Bochicchio K, Tracy K, Scalea TM. Admission hyperglycemia is predictive of outcome in critically ill trauma patients. J Trauma. 2005;59:80–83. CrossRef
- Srinivasan V, Spinella PC, Drott HR, Roth CL, Helfaer MA, Nadkarni V. Association of timing, duration and intensity of hyperglycemia with intensive care unit mortality in critically ill children. Pediatr Crit Care Med. 2004; 5:329–336. CrossRef
- Van den Berghe G, Woulters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, et al. Intensive insulin therapy in critically ill. N Engl J Med. 2001;345:1359–1367. CrossRef
- Krinsley JS. Effect of an intensive glucose management protocol on the mortality of critically ill adult patients. Mayo Clin Proc. 2004;79:992–1000. CrossRef
- Van den Berghe G, Wilmer A, Hermans G, Meersseman W, Wouters PJ, Milants I, et al. Intensive insulin therapy in the medical ICU. N Engl J Med. 2006; 354: 449–461. CrossRef
- Treggiari MM, Karir V, Yanez ND, Weiss NS, Daniel S, Deem SA. Intensive insulin therapy and mortality in critically ill patients. Crit Care. 2008;12: R29. CrossRef
- Wang LC, Lei S, Wu YC, Wu JN, Wang LF, Guan TR, et al. Intensive insulin therapy in critically ill patients. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2006; 18:748–750.
- Arabi YM, Dabbagh OC, Tamim HM, Al-Shimemeri, Memish ZA, Haddad SH, et al. Intensive versus conventional insulin therapy: A randomised controlled trial in medical and surgical critically ill patients. Crit Care Med. 2008; 36:3190–3197. CrossRef
- Brunkhorst FM, Engel C, Bloos F, Meier-Hellman A, Ragaller M, Weiler N, et al. Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med. 2008;358:125–139. CrossRef
- Devos P, Preiser JC, Melot C. Impact of tight glucose control by intensive insulin therapy on ICU mortality and the rate of hypoglycemia: final results of the Glucontrol. Intensive Care Med. 2007;33:(Suppl 2):S189.
- Wiener RS, Wiener DC, Larson RJ. Benefits and risks of tight glucose control in critically ill adults: A meta analysis. JAMA. 2008;300:933–944. CrossRef
- The NICE-SUGAR study investigators. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360:1283–1297. CrossRef
- Griesdale DEG, de Souza RJ, van Dam RM, Heyland DK, Cook DJ, Malhotra A, et al. Intensive insulin therapy and mortality among critically ill patients: a meta-analysis including NICE-SUGAR study data. CMAJ. 2009; 180:821–827. CrossRef
- Egi M, Bellomo R, Stachowski E, French CJ, Hart G. Variability of blood glucose concentration and short-term mortality in critically ill patients. Anesthesiology. 2006;105:244–252. CrossRef
- Ali NA, O’Brien JM, Jr., Dungan K, Phillips G, Marsh CB, Lemeshow S, et al. Glucose variability and mortality in patients with sepsis. Crit Care Med. 2008; 36:2316–2321. CrossRef
- Bagshaw SM, Bellomo R, Jacka MJ, Egi M, Hart GK, George C. The impact of early hypoglycemia and blood glucose variability on outcome in critical illness. Crit Care. 2009;13:R91. CrossRef
- Hermanides J, Vriesendorp TM, Bosman RJ, Zandstra DF, Hoekstra JB, Devries JH. Glucose variability is associated with intensive care unit mortality. Crit Care Med. 2010;38:838–842. CrossRef
- Faustino EV, Apkon M. Persistent hyperglycemia in critically ill children. J Pediatr. 2005;146:30–34. CrossRef
- Branco RDG, Tasker RC. Glycemic level in mechanically ventilated children with bronchiolitis. Pediatr Crit Care Med. 2007;8:546–550. CrossRef
- Day KM, Haub N, Betts H, Inwald DP. Hyperglycemia is associated with morbidity in critically ill children with meningococcal sepsis. Pediatr Crit Care Med. 2008;9:636–640. CrossRef
- Branco RG, Garcia PCR, Piva JP, Casartelli CH, Seibel V, Tasker RC. Glucose level and risk of mortality in pediatric septic shock. Pediatr Crit Care Med. 2005;6:470–472. CrossRef
- Wintergrest KA, Buckingham B, Gandrud L, Wong BJ, Kache S, Wilson DM. Association of hyperglycemia, hypoglycemia and glucose variability with morbidity and death in the paediatric intensive care unit. Pediatrics. 2006;118:173–179. CrossRef
- Hirshberg E, Larsen G, van Duker H. Alterations in glucose homeostasis in the pediatric intensive care unit: Hyperglycemia and glucose variability are associated with increased mortality and morbidity. Pediatr Crit Care Med. 2008; 9:361–366. CrossRef
- Nayak P, Lang H, Parslow RC, Morris K. Hyperglycemia and insulin therapy in the critically ill child. Pediatr Crit Care Med. 2009;10:303–305. CrossRef
- Yung M, Wilkins B, Norton L, Slater A. Glucose control, organ failure, and mortality in pediatric intensive care. Pediatr Crit Care Med. 2008;9:147–152. CrossRef
- Preissig CM, Hansen I, Roerig PL, Rigby MR. A protocolized approach to identify and manage hyperglycemia in a pediatric critical care unit. Pediatr Crit Care Med. 2008;9:581–588. CrossRef
- Vlasselaers D, Milants I, Desmet L, Wouters PJ, Vanhorebeek I, van den Heuvel I, et al. Intensive insulin therapy for patients in paediatric intensive care: a prospective, randomized controlled study. Lancet. 2009;373:547–556. CrossRef
- Maintaining normal blood sugar levels in children undergoing heart surgery to reduce the risk of infections and improve recovery (The SPECS study). http://clinicaltrials.gov/ct2/show/NCT00443599. Accessed October 10, 2010.
- Macrae D, Pappachan J, Grieve R, Parslow R, Nadel S, Schindler M, et al. Control of hyperglycemia in paediatric intensive care (CHiP): study protocol. BMC Paediatrics. 2010;10:5. CrossRef
- Pediatric ICUs at Emory-Children’s Centre Glycemic Control: The PedETrol Trial. http://clinicaltrials.gov/ct2/show/NCT01116752. Accessed October 10, 2010.
- Chwals WJ. Hyperglycemia management strategy in the pediatric intensive care setting. Pediatr Crit Care Med. 2008;9:656–658. CrossRef
- Vincent J. Blood glucose control in 2010. 110 to 150 mg/dL and minimal variability. Crit Care Med. 2010;38:993–995. CrossRef
- Jeschke MG, Kraft R, Emdad F, Kulp GA, Williams FN, Herndon DN. Glucose control in severely thermally injured pediatric patients: what glucose range should be the target? Ann Surg. 2010;252:521–527.
- Treating hyperglycemia in the critically ill child: Is there enough evidence?
Volume 48, Issue 7 , pp 531-536
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Critical illness
- Banani Poddar (1)
- Author Affiliations
- 1. Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India