Bacterial respiratory tract infections are promoted by systemic hyperglycemia after severe burn injury in pediatric patients.
BACKGROUND
Burns are associated with hyperglycemia leading to increased incidence of infections with pneumonia being one of the most prominent and adverse complications. Recently, various studies in critically ill patients indicated that increased pulmonary glucose levels with airway/blood glucose threshold over 150 mg/dl lead to an overwhelming growth of bacteria in the broncho-pulmonary system, subsequently resulting in an increased risk of pulmonary infections. The aim of the present study was to determine whether a similar cutoff value exists for severely burned pediatric patients.


METHODS
One-hundred six severely burned pediatric patients were enrolled in the study. Patients were divided in two groups: high (H) defined as daily average glucose levels >75% of LOS >150 mg/dl), and low (L) with daily average glucose levels >75% of the LOS <150 mg/dl). Incidences of pneumonia, atelectasis, and acute respiratory distress syndrome (ARDS) were assessed. Incidence of infections, sepsis, and respiratory parameters were recorded. Blood was analyzed for glucose and insulin levels. Statistical analysis was performed using Student's t-test and chi-square test. Significance was set at p<0.05.


RESULTS
Patient groups were similar in demographics and injury characteristics. Pneumonia in patients on the mechanical ventilation (L: 21%, H: 32%) and off mechanical ventilation (L: 5%, H: 15%), as well as ARDS were significantly higher in the high group (L: 3%, H: 19%), p<0.05, while atelectasis was not different. Patients in the high group required significantly longer ventilation compared to low patients (p<0.05). Furthermore, incidence of infection and sepsis were significantly higher in the high group, p<0.05.


CONCLUSIONS
Our results indicate that systemic glucose levels over 150 mg/dl are associated with a higher incidence of pneumonia confirming the previous studies in critically ill patients.
Department of Trauma, Klinikum Memmingen, Germany.
Robert
R
Kraft
Shriners Hospitals for Children, Galveston, TX, United States; Department of Surgery, United States.
David N
DN
Herndon
Shriners Hospitals for Children, Galveston, TX, United States.
Ronald P
RP
Mlcak
Shriners Hospitals for Children, Galveston, TX, United States; Department of Surgery, United States; Sealy Center for Molecular Medicine, and the Institute for Translational Science, University Texas Medical Branch, Galveston, TX, United States.
Celeste C
CC
Finnerty
Shriners Hospitals for Children, Galveston, TX, United States.
Robert A
RA
Cox
Shriners Hospitals for Children, Galveston, TX, United States.
Felicia N
FN
Williams
Department of Surgery, Division of Plastic Surgery, Department of Immunology, Ross Tilley Burn Centre - Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, ON, Canada. Electronic address: marc.jeschke@sunnybrook.ca.
Marc G
MG
Jeschke
D000293:Adolescent; D002056:Burns / Q000150:complications / Q000378:metabolism*; D002059:Burns, Inhalation / Q000150:complications / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D005260:Female; D005947:Glucose / Q000378:metabolism*; D006801:Humans; D006943:Hyperglycemia / Q000150:complications / Q000378:metabolism*; D007223:Infant; D015601:Injury Severity Score; D008297:Male; D018410:Pneumonia, Bacterial / Q000209:etiology / Q000378:metabolism*; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000378:metabolism; D012141:Respiratory Tract Infections / Q000209:etiology / Q000378:metabolism; D018805:Sepsis / Q000209:etiology / Q000378:metabolism
D005947:Glucose
Airway glucose threshold; Bacterial growth; Hyperglycemia; Pneumonia; Respiratory tract infections