Control of hyperglycaemia in paediatric intensive care (CHiP): study protocol.
BACKGROUND
There is increasing evidence that tight blood glucose (BG) control improves outcomes in critically ill adults. Children show similar hyperglycaemic responses to surgery or critical illness. However it is not known whether tight control will benefit children given maturational differences and different disease spectrum.


METHODS
The study is an randomised open trial with two parallel groups to assess whether, for children undergoing intensive care in the UK aged <or= 16 years who are ventilated, have an arterial line in-situ and are receiving vasoactive support following injury, major surgery or in association with critical illness in whom it is anticipated such treatment will be required to continue for at least 12 hours, tight control will increase the numbers of days alive and free of mechanical ventilation at 30 days, and lead to improvement in a range of complications associated with intensive care treatment and be cost effective. Children in the tight control group will receive insulin by intravenous infusion titrated to maintain BG between 4 and 7.0 mmol/l. Children in the control group will be treated according to a standard current approach to BG management. Children will be followed up to determine vital status and healthcare resources usage between discharge and 12 months post-randomisation. Information regarding overall health status, global neurological outcome, attention and behavioural status will be sought from a subgroup with traumatic brain injury (TBI). A difference of 2 days in the number of ventilator-free days within the first 30 days post-randomisation is considered clinically important. Conservatively assuming a standard deviation of a week across both trial arms, a type I error of 1% (2-sided test), and allowing for non-compliance, a total sample size of 1000 patients would have 90% power to detect this difference. To detect effect differences between cardiac and non-cardiac patients, a target sample size of 1500 is required. An economic evaluation will assess whether the costs of achieving tight BG control are justified by subsequent reductions in hospitalisation costs.


CONCLUSIONS
The relevance of tight glycaemic control in this population needs to be assessed formally before being accepted into standard practice.
Paediatric Intensive Care Unit, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK. D.macrae@rbht.nhs.uk
Duncan
D
Macrae
John
J
Pappachan
Richard
R
Grieve
Roger
R
Parslow
Simon
S
Nadel
Margrid
M
Schindler
Paul
P
Baines
Peter-Marc
PM
Fortune
Zdenek
Z
Slavik
Allan
A
Goldman
Ann
A
Truesdale
Helen
H
Betts
Elizabeth
E
Allen
Claire
C
Snowdon
Deborah
D
Percy
Michael
M
Broadhead
Tara
T
Quick
Mark
M
Peters
Kevin
K
Morris
Robert
R
Tasker
Diana
D
Elbourne
D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D016638:Critical Illness / Q000628:therapy; D016903:Drug Monitoring; D004739:England; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D007223:Infant; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D015278:Intensive Care Units, Pediatric; D018579:Patient Selection; D011183:Postoperative Complications / Q000097:blood / Q000628:therapy; D012107:Research Design; D012121:Respiration, Artificial; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D015300:Ventilator Weaning / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000097:blood / Q000628:therapy
D007328:Insulin; D014662:Vasoconstrictor Agents