Glucose control in severely thermally injured pediatric patients: what glucose range should be the target?
OBJECTIVE
To determine which glucose levels are associated with improved morbidity and mortality in thermally injured patients.


BACKGROUND
Tight euglycemic control was rapidly implemented in intensive care units around the world, but there is increasing evidence that tight euglycemic control is associated with detrimental outcomes. Currently, no study exists that indicates which glucose range should be targeted.


METHODS
Two-hundred and eight severely burned pediatric patients with burns over 30% of their total body surface area were included in this trial. Several statistical models were used to determine the daily average and 6 AM glucose target that were associated with improved morbidity and mortality. Patients were then divided into good glucose controlled and poor glucose controlled patients and demographics, clinical outcomes, infection, sepsis, inflammatory, and hypermetabolic responses were determined.


RESULTS
Statistical modeling showed that hyperglycemia is a strong predictor of adverse hospital outcome and that daily 6 am glucose level of 130 mg/dL and daily average glucose levels of 140 mg/dL are associated with improved morbidity and mortality postburn. When patients were divided into good glucose control and poor glucose control, we found that patients with glucose levels of 130 mg/dL exert attenuated hypermetabolic and inflammatory responses, as well as significantly lower incidence of infections, sepsis, and mortality compared with patients with poor glucose control, P < 0.05.


CONCLUSIONS
Given the controversy over glucose range, glucose target, and risks and detrimental outcomes associated with hypoglycemia we suggest that in severely burned patient's blood glucose of 130 mg/dL should be targeted.
Jeschke
Marc G
MG
Shriners Hospitals for Children, Biochemistry and Molecular Biology, Galveston, TX, USA. majeschk@utmb.edu
Kraft
Robert
R
Emdad
Fatemeh
F
Kulp
Gabriela A
GA
Williams
Felicia N
FN
Herndon
David N
DN
D001786:Blood Glucose / Q000378:metabolism*; D002056:Burns / Q000097:blood* / Q000150:complications / Q000401:mortality; D002153:Calorimetry, Indirect; D002648:Child; D002851:Chromatography, High Pressure Liquid; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood* / Q000209:etiology / Q000401:mortality; D007003:Hypoglycemia / Q000097:blood* / Q000209:etiology / Q000401:mortality; D007333:Insulin Resistance; D007362:Intensive Care Units / Q000592:standards; D008297:Male; D015233:Models, Statistical; D009391:Nephelometry and Turbidimetry; D011237:Predictive Value of Tests
D001786:Blood Glucose