title: Clinical equipoise regarding glycemic control: a survey of pediatric intensivist perceptions.
abstract: OBJECTIVE
  To assess the willingness of pediatric intensivists to conduct a pediatric trial of blood glucose control, and to determine if self-reported practices were influenced by adult-specific data over the past 4 yrs. This was a follow-up to our previous 2005 survey.
  
  
  METHODS
  Electronic survey comprising a 30-item questionnaire.
  
  
  METHODS
  North American PICUs that were members of, or connected to, the Pediatric Acute Lung Injury and Sepsis Network (n = 96 targeted institutions).
  
  
  METHODS
  North American pediatric intensivists (n = 209).
  
  
  METHODS
  None.
  
  
  METHODS
  We conducted a survey of North American PICUs using a Web-based questionnaire. Invitations were sent to 96 institutions in 37 states/provinces.
  
  
  RESULTS
  Response rate was 68% (141/209). The median definitions of hyperglycemia (150 mg/dL) and hypoglycemia (≤60 mg/dL) were similar to our 2005 survey results. Self-reported practice patterns remain variable. Although 75% of clinician respondents denied a change in clinical practice based on the published literature, the preferred blood glucose target range increased from 80-110 mg/dL in 2005 to 90-140 mg/dL in 2009. Intensivists who preferred a blood glucose target of 80-110 mg/dL decreased from 43% to 6% (p < 0.001). Many respondents (45%) indicated that the acceptable severe hypoglycemia rate (% patients) for a protocol was ≤2.5%. The majority (93%) indicated they would be willing to enroll patients in a pediatric trial of blood glucose control.
  
  
  CONCLUSIONS
  Pediatric intensivists report that they control blood glucose with insulin in critically ill children and do not necessarily adopt adult-specific data or a single uniform blood glucose target. The published evidence does not adequately address PICU clinicians concerns. Unanswered questions and persistent variation in practice suggest a need for a multicenter clinical trial of blood glucose control in critically ill children.
authors.affiliation: Department of Pediatrics, University of Utah, Primary Children's Medical Center, Intermountain Medical Center, Murray, UT, USA. ellie.hirshberg@hsc.utah.edu
authors.forename: Eliotte L
authors.initials: EL
authors.lastname: Hirshberg
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Sward
authors.forename: Edward Vincent S
authors.initials: EV
authors.lastname: Faustino
authors.forename: Vinay M
authors.initials: VM
authors.lastname: Nadkarni
authors.forename: Michael S D
authors.initials: MS
authors.lastname: Agus
authors.forename: Alan H
authors.initials: AH
authors.lastname: Morris
authors.forename: Jacques
authors.initials: J
authors.lastname: Lacroix
mesh_terms: D001291:Attitude of Health Personnel; D001786:Blood Glucose / Q000378:metabolism; D002986:Clinical Trials as Topic; D003422:Critical Care / Q000379:methods*; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000517:prevention & control*; D007003:Hypoglycemia / Q000097:blood / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D007328:Insulin / Q000008:administration & dosage; D015278:Intensive Care Units, Pediatric; D010820:Physicians / Q000523:psychology*; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires; D057212:Therapeutic Equipoise
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin