title: Strict glycemic targets need not be so strict: a more permissive glycemic range for critically ill children.
abstract: OBJECTIVE
  The goal was to determine whether a more permissive glycemic target would be associated with a decreased incidence of hypoglycemia but not increased mortality rates in critically ill pediatric patients.
  
  
  METHODS
  This retrospective study evaluated clinical and laboratory data for 177 patients who underwent 211 consecutive surgical procedures for repair or palliation of congenital heart defects at Driscoll Children's Hospital. To establish the relationship between postoperative glycemia and subsequent morbidity and mortality rates, patients were stratified into 4 groups according to their median glucose levels, that is, euglycemia (60-125 mg/dL, 3.3-6.9 mmol/L), mild hyperglycemia (126-139 mg/dL, 6.9-7.7 mmol/L), moderate hyperglycemia (140-179 mg/dL, 7.7-9.9 mmol/L), or severe hyperglycemia (>or=180 mg/dL, >or=9.9 mmol/L). Postoperative outcomes for those groups also were compared with outcomes for a more permissive glycemic target group (90-140 mg/dL, 5-7.7 mmol/L).
  
  
  RESULTS
  The peak and mean blood glucose measurements and duration of hyperglycemia were not different for survivors and nonsurvivors in the first 24 hours after surgery. Nonsurvivors had higher peak glucose levels (389.3 +/- 162 mg/dL vs 274.4 +/- 106.3 mg/dL, 21.4 +/- 8.9 mmol/L vs 15.1 +/- 5.9 mmol/L) and longer duration of hyperglycemia (3.06 +/- 1.67 days vs 2.11 +/- 0.92 days) during the first 5 postoperative days, compared with survivors. Mortality rates were significantly higher for the moderate (38.8%) and severe (58.3%) hyperglycemia groups, compared with the euglycemia (6.02%) and permissive target (4.69%) groups. The incidence of hypoglycemia was significantly higher in the euglycemia group (31.8%), compared with the permissive target group (17.18%).
  
  
  CONCLUSIONS
  Postoperative hyperglycemia is associated with increased morbidity and mortality rates in children after surgical repair of congenital heart defects. A more permissive glycemic target is associated with a lower incidence of hypoglycemia but not increased mortality rates in these patients.
authors.affiliation: Department of Pediatrics, Driscoll Children's Hospital, Corpus Christi, TX 78411, USA.
authors.forename: Kalia Patricia
authors.initials: KP
authors.lastname: Ulate
authors.forename: Germano Correia
authors.initials: GC
authors.lastname: Lima Falcao
authors.forename: Mark Richard
authors.initials: MR
authors.lastname: Bielefeld
authors.forename: John Mark
authors.initials: JM
authors.lastname: Morales
authors.forename: Alexandre Tellechea
authors.initials: AT
authors.lastname: Rotta
mesh_terms: D001786:Blood Glucose / Q000378:metabolism*; D002675:Child, Preschool; D016638:Critical Illness / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D005951:Glucose Tolerance Test; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control*; D007003:Hypoglycemia / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control*; D015994:Incidence; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013781:Texas / Q000453:epidemiology; D013997:Time Factors
chemical_list: D001786:Blood Glucose