Blood glucose control in critically ill adults and children: a survey on stated practice.
OBJECTIVE
We document clinicians' stated blood glucose control practice patterns in North American pediatric and adult ICUs.


METHODS
Using a Web-based self-administered questionnaire, we conducted a nationwide survey of North American pediatric and adult ICUs. Participants included ICU medical directors, nurses, fellows in training, and attending intensivists from participating ICUs in three critical care research networks.


RESULTS
Item generation and item selection were performed according to standard scientific survey methods. Questions were designed to describe clinicians' perceptions about glucose control practices. The questionnaire topics included the following: respondent characteristics; ICU description; hyperglycemia; hypoglycemia; and glucose measurement. The institutional response rate was 96% (50 of 52 institutions). The clinician response rate was 58% (163 of 282 physicians). Adult ICU clinicians defined hyperglycemia (120 mg/dL [6.2 mmol/L]) at a lower threshold than pediatric ICU clinicians (150 mg/dL [8.3 mmol/L]). Hypoglycemia was defined similarly by both groups (median, < or = 60 mg/dL [3.3 mmol/L]; range, 40 to 80 mg/dL [2.2 to 4.4 mmol/L]). More pediatric ICU clinicians (84.5%) than adult ICU clinicians (59.1%) considered hypoglycemia to be more dangerous than hyperglycemia. A larger percentage of adult ICU clinicians (82.5%) than pediatric ICU clinicians (49.3%) preferred a target blood glucose level between 80 and 110 mg/dL (4.4 to 6.1 mmol/L). Clinical algorithms for glucose management varied among clinicians and across institutions.


CONCLUSIONS
Blood glucose control with insulin is used frequently for critically ill adults and children. A wide variation in practice exists in blood glucose targets, hyperglycemia and hypoglycemia definitions, and decision algorithms among North American adult and pediatric ICUs.
Hirshberg
Eliotte
E
University of Utah, Salt Lake City, UT. Electronic address: ellie.hirshberg@hsc.utah.edu.
Lacroix
Jaques
J
Université de Montréal, Montréal, QC, Canada.
Sward
Kathy
K
University of Utah, Salt Lake City, UT.
Willson
Douglas
D
University of Virginia, Charlottesville, VA.
Morris
Alan H
AH
University of Utah, Salt Lake City, UT.
D000328:Adult; D000465:Algorithms; D001786:Blood Glucose; D002648:Child; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood* / Q000188:drug therapy; D007003:Hypoglycemia / Q000097:blood* / Q000188:drug therapy; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D007362:Intensive Care Units / Q000145:classification / Q000706:statistics & numerical data*; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D008297:Male; D012128:Respiratory Distress Syndrome / Q000097:blood*; D011795:Surveys and Questionnaires
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin