Amino acid concentrations in critically ill children following cardiac surgery*.
OBJECTIVE
Guidelines for administering amino acids to critically ill children are largely based on uncontrolled observational studies and expert opinion, without support from rigorous outcome studies. Also, data on circulating amino acid concentrations during critical illness are scarce. We thoroughly studied the time profiles of circulating amino acid concentrations in critically ill children who received standard nutritional care according to international guidelines.


METHODS
This is a subanalysis of pediatric critically ill patients included in a large (n = 700) randomized controlled study on intensive insulin therapy.


METHODS
The study was conducted at a university hospital PICU.


METHODS
We studied 100 patients in PICU for at least 3 days following cardiac surgery.


METHODS
Patients were assigned to intensive insulin therapy targeting normal-for-age fasting blood glucose concentrations or insulin infusion only to prevent excessive hyperglycemia.


RESULTS
Plasma amino acid concentrations were measured at admission, day 3, and day 7 in PICU. At admission, the concentrations of most amino acids were comparable to those reported for healthy children. Total amino acid concentrations remained stable during ICU stay, but individual amino acids showed different time profiles with eight of them showing an increase and five a decrease. Nonsurviving children had higher total amino acid concentrations and individual amino acids compared with survivors at admission and/or during ICU stay. Intensive insulin therapy lowered the concentrations of total amino acids and several individual amino acids. Neonates showed somewhat different amino acid profiles with rather increased concentrations from baseline with time in ICU for total amino acids and several individual amino acids as compared with older infants and children.


CONCLUSIONS
Circulating amino acid concentrations in critically ill children after cardiac surgery differ according to survival status, blood glucose control with intensive insulin therapy, and age.
1Clinical Department and Laboratory of Intensive Care Medicine, Division of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium. 2Department of Anaesthesiology and Intensive Care, Karolinska University Hospital, Huddinge, Sweden. 3Department of Clinical Science Intervention and Technology, CLINTEC, Karolinska Institutet, Huddinge, Sweden.
Marijke
M
Gielen
Ilse
I
Vanhorebeek
Pieter J
PJ
Wouters
Dieter
D
Mesotten
Jan
J
Wernerman
Greet
G
Van den Berghe
Olav
O
Rooyackers
D000367:Age Factors; D000596:Amino Acids / Q000097:blood* / Q000187:drug effects; D001786:Blood Glucose / Q000378:metabolism; D006348:Cardiac Surgical Procedures; D016638:Critical Illness / Q000401:mortality; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007223:Infant; D007231:Infant, Newborn; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D009752:Nutritional Status; D010288:Parenteral Nutrition; D011184:Postoperative Period; D015996:Survival Rate; D013997:Time Factors
D000596:Amino Acids; D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin