Glucose control, organ failure, and mortality in pediatric intensive care.
OBJECTIVE
In ventilated children, to determine the prevalence of hyperglycemia, establish whether it is associated with organ failure, and document glycemic control practices in Australasian pediatric intensive care units (PICUs).


METHODS
Prospective inception cohort study.


METHODS
All nine specialist PICUs in Australia and New Zealand.


METHODS
Children ventilated > 12 hrs excluding those with diabetic ketoacidosis, on home ventilation, undergoing active cardiopulmonary resuscitation on admission, or with do-not-resuscitate orders.


METHODS
None.


RESULTS
All blood glucose measurements for up to 14 days, clinical and laboratory values needed to calculate Paediatric Logistic Organ Dysfunction (PELOD) scores, and insulin use were recorded in 409 patients. Fifty percent of glucose measurements were > 6.1 mmol/L, with 89% of patients having peak values > 6.1 mmol/L. The median time to peak blood glucose was 7 hrs. Hyperglycemia was defined by area under the glucose-time curve > 6.1 mmol/L above the sample median. Thirteen percent of hyperglycemic subjects died vs. 3% of nonhyperglycemic subjects. There was an independent association between hyperglycemia and a PELOD score > or = 10 (odds ratio 3.41, 95% confidence interval 1.91-6.10) and death (odds ratio 3.31, 95% confidence interval 1.26-7.7). Early hyperglycemia, defined using only glucose data in the first 48 hrs, was also associated with these outcomes but not with PELOD > or = 10 after day 2 or with worsening PELOD after day 1. Five percent of patients received insulin.


CONCLUSIONS
Hyperglycemia is common in PICUs, occurs early, and is independently associated with organ failure and death. However, early hyperglycemia is not associated with later or worsening organ failure. Australasian PICUs seldom use insulin.
Yung
Michael
M
The Women's and Children's Hospital, Adelaide, South Australia.
Wilkins
Barry
B
Norton
Lynda
L
Slater
Anthony
A
D001315:Australia / Q000453:epidemiology; D001786:Blood Glucose / Q000032:analysis*; D002675:Child, Preschool; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology / Q000401:mortality* / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007223:Infant; D007328:Insulin / Q000627:therapeutic use; D015278:Intensive Care Units, Pediatric; D008297:Male; D009102:Multiple Organ Failure / Q000401:mortality*; D009520:New Zealand / Q000453:epidemiology; D011446:Prospective Studies; D012121:Respiration, Artificial; D012720:Severity of Illness Index
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin