title: Glycemic control for postoperative pediatric cardiac patients.
abstract: This study aimed to determine the prevalence of hyperglycemia among pediatric postoperative cardiac patients, its impact on outcomes, and whether hyperglycemia can be controlled effectively in this population. A retrospective chart review of 100 postoperative patients admitted to the authors' pediatric cardiac intensive care unit (ICU) was conducted. Patients were evaluated for incidence of hyperglycemia, defined as blood glucose (BG) level exceeding 7.7 mmol/l (140 mg/dl), and outcomes. The evaluation also included 20 different postoperative patients with a BG level exceeding 7.7 mmol/l (140 mg/dl) who received management with insulin via the authors' pediatric-specific glycemic control protocol. The BG control and hypoglycemic rates in this cohort were assessed. The prevalence of hyperglycemia was 84%. The hyperglycemic patients had higher inotrope scores, longer hospital stays, more mechanical ventilation days, and higher mortality rates than those without hyperglycemia. For the patients with hyperglycemia managed via the authors' pediatric-specific glycemic control protocol, 62% of all BG values were within the authors' goal range, and less than 4% of BG values were less than 3.3 mmol/l (60 mg/dl). No patient had a BG level lower than 2.2 mmol/l (40 mg/dl) during glycemic management. Severe hyperglycemia is prevalent among postoperative pediatric cardiac patients and correlates with morbidity and mortality. Hyperglycemia may be controlled effectively in these patients using a pediatric-specific glycemic control protocol without increasing the incidence of hypoglycemia.
authors.affiliation: Department of Pediatrics, Division of Critical Care Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA. catherine.preissig@choa.org
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Preissig
authors.forename: Mark R
authors.initials: MR
authors.lastname: Rigby
authors.forename: Kevin O
authors.initials: KO
authors.lastname: Maher
mesh_terms: D000293:Adolescent; D001786:Blood Glucose / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D005260:Female; D038321:Glycemic Index; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007328:Insulin / Q000627:therapeutic use*; D015278:Intensive Care Units, Pediatric; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D011184:Postoperative Period; D015995:Prevalence; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin
references.citation: J Pediatr. 2008 Sep;153(3):379-84
references.pmid: 18534209
references.citation: Nature. 2001 Dec 13;414(6865):799-806
references.pmid: 11742412
references.citation: J Trauma. 2005 Jan;58(1):47-50
references.pmid: 15674149
references.citation: Ann Intern Med. 2007 Feb 20;146(4):233-43
references.pmid: 17310047
references.citation: N Engl J Med. 2006 Feb 2;354(5):449-61
references.pmid: 16452557
references.citation: Pediatr Crit Care Med. 2008 Mar;9(2):147-52
references.pmid: 18477927
references.citation: J Thorac Cardiovasc Surg. 2002 Jan;123(1):110-8
references.pmid: 11782764
references.citation: Circulation. 1995 Oct 15;92(8):2226-35
references.pmid: 7554206
references.citation: Pediatr Crit Care Med. 2008 Nov;9(6):581-8
references.pmid: 18838924
references.citation: Pediatr Crit Care Med. 2004 Jul;5(4):329-36
references.pmid: 15215001
references.citation: Circulation. 2004 Mar 30;109(12):1497-502
references.pmid: 15006999
references.citation: Pediatr Crit Care Med. 2006 Jul;7(4):351-5
references.pmid: 16738506
references.citation: Cancer Res. 1986 Dec;46(12 Pt 1):6299-304
references.pmid: 3779648
references.citation: J Trauma. 2003 Dec;55(6):1035-8
references.pmid: 14676647
references.citation: J Thorac Cardiovasc Surg. 2003 May;125(5):1007-21
references.pmid: 12771873
references.citation: Pediatrics. 2006 Jul;118(1):173-9
references.pmid: 16818563
references.citation: JAMA. 2003 Oct 15;290(15):2041-7
references.pmid: 14559958
references.citation: N Engl J Med. 2008 Jan 10;358(2):125-39
references.pmid: 18184958
references.citation: Crit Care Med. 2007 Oct;35(10):2262-7
references.pmid: 17717490
references.citation: Diabetes. 2002 Apr;51(4):1076-82
references.pmid: 11916928
references.citation: Circulation. 2009 Jan 20;119(2):351-7
references.pmid: 19095622
references.citation: N Engl J Med. 2001 Nov 8;345(19):1359-67
references.pmid: 11794168
references.citation: Curr Opin Clin Nutr Metab Care. 2006 Mar;9(2):124-30
references.pmid: 16477177
references.citation: Lancet. 2005 Jan 1-7;365(9453):53-9
references.pmid: 15639679
references.citation: J Trauma. 2004 May;56(5):1058-62
references.pmid: 15179246
references.citation: Crit Care Clin. 2001 Jan;17(1):107-24
references.pmid: 11219223
references.citation: Chest. 2008 Jun;133(6):1328-1335
references.pmid: 18339779
references.citation: J Pediatr. 2005 Jan;146(1):30-4
references.pmid: 15644818
references.citation: Diabetes. 2002 Jun;51(6):1938-48
references.pmid: 12031984
references.citation: Pediatr Crit Care Med. 2005 Jul;6(4):470-2
references.pmid: 15982437
references.citation: Endocr Pract. 2004 Mar-Apr;10 Suppl 2:4-9
references.pmid: 15251633
references.citation: Curr Opin Clin Nutr Metab Care. 2007 Mar;10(2):206-9
references.pmid: 17285011