Management of hyperglycemia in the pediatric intensive care unit; implementation of a glucose control protocol.
OBJECTIVE
To evaluate a stepwise nurse-driven glucose control protocol for the treatment of hyperglycemia in critically ill pediatric patients.


METHODS
Academic pediatric intensive care unit.


METHODS
Prospective observational study.


METHODS
A total of 50 consecutively admitted critically ill children with hyperglycemia >8 mmol/L (>145 mg/dL) were included and treated according to the glucose control protocol.


RESULTS
Demographic data and clinical parameters were collected and different steps in the protocol were evaluated. Data were expressed as medians with interquartile ranges. Fifty children (28 boys), aged 3.5 yrs (range, 1.2 -9.3 yrs) were treated in 18 mos. Forty-two children had multiple organ failure. Eight children died. Insulin treatment was initiated 4 hrs after the first episode of hyperglycemia was documented (median blood glucose, 11.4 mmol/L, [207 mg/dL] [9.7-14.5 mmol/L, 176-264 mg/dL]). Blood glucose was <8 mmol/L (<145 mg/dL) within 12 hrs of initiating insulin therapy in 47 (94%) of 50 children (median, 5 hrs). Duration of treatment was 34 hrs (17-72 hrs) and the maximum insulin dose ranged between 20 and 200 mIU/kg/hr (median, 70 mIU/kg/hr). Episodes of severe hypoglycemia <2.2 mmol/L (<47 mg/dL) did not occur.


CONCLUSIONS
The use of a stepwise nurse-driven glucose control protocol resulted in normoglycemia within 12 hrs for 94% of the children involved. Episodes of severe hypoglycemia did not occur. We conclude that the glucose control protocol is effective in treating hyperglycemia in critically ill children. Further studies are necessary to assess safety before the protocol could also be implemented in other pediatric intensive care units.
Verhoeven
Jennifer J
JJ
Intensive Care, Erasmus MC-Sophia Children's Hospital Rotterdam, Rotterdam, The Netherlands.
Brand
Jeannette B
JB
van de Polder
Mirjam M
MM
Joosten
Koen F M
KF
D001786:Blood Glucose / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000451:nursing / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007223:Infant; D007262:Infusions, Intravenous; D007328:Insulin / Q000627:therapeutic use*; D015278:Intensive Care Units, Pediatric; D008297:Male; D009102:Multiple Organ Failure / Q000628:therapy; D009426:Netherlands; D011446:Prospective Studies
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin