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Glucose control, organ failure, and mortality in pediatric intensive care.
Pediatr Crit Care Med. 2008 Mar; 9(2):147-52.PC

Abstract

OBJECTIVE

In ventilated children, to determine the prevalence of hyperglycemia, establish whether it is associated with organ failure, and document glycemic control practices in Australasian pediatric intensive care units (PICUs).

DESIGN

Prospective inception cohort study.

SETTING

All nine specialist PICUs in Australia and New Zealand.

PATIENTS

Children ventilated > 12 hrs excluding those with diabetic ketoacidosis, on home ventilation, undergoing active cardiopulmonary resuscitation on admission, or with do-not-resuscitate orders.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

All blood glucose measurements for up to 14 days, clinical and laboratory values needed to calculate Paediatric Logistic Organ Dysfunction (PELOD) scores, and insulin use were recorded in 409 patients. Fifty percent of glucose measurements were > 6.1 mmol/L, with 89% of patients having peak values > 6.1 mmol/L. The median time to peak blood glucose was 7 hrs. Hyperglycemia was defined by area under the glucose-time curve > 6.1 mmol/L above the sample median. Thirteen percent of hyperglycemic subjects died vs. 3% of nonhyperglycemic subjects. There was an independent association between hyperglycemia and a PELOD score > or = 10 (odds ratio 3.41, 95% confidence interval 1.91-6.10) and death (odds ratio 3.31, 95% confidence interval 1.26-7.7). Early hyperglycemia, defined using only glucose data in the first 48 hrs, was also associated with these outcomes but not with PELOD > or = 10 after day 2 or with worsening PELOD after day 1. Five percent of patients received insulin.

CONCLUSIONS

Hyperglycemia is common in PICUs, occurs early, and is independently associated with organ failure and death. However, early hyperglycemia is not associated with later or worsening organ failure. Australasian PICUs seldom use insulin.

Authors+Show Affiliations

The Women's and Children's Hospital, Adelaide, South Australia.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18477927

Citation

Yung, Michael, et al. "Glucose Control, Organ Failure, and Mortality in Pediatric Intensive Care." Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, vol. 9, no. 2, 2008, pp. 147-52.
Yung M, Wilkins B, Norton L, et al. Glucose control, organ failure, and mortality in pediatric intensive care. Pediatr Crit Care Med. 2008;9(2):147-52.
Yung, M., Wilkins, B., Norton, L., & Slater, A. (2008). Glucose control, organ failure, and mortality in pediatric intensive care. Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 9(2), 147-52. https://doi.org/10.1097/PCC.0b013e3181668c22
Yung M, et al. Glucose Control, Organ Failure, and Mortality in Pediatric Intensive Care. Pediatr Crit Care Med. 2008;9(2):147-52. PubMed PMID: 18477927.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Glucose control, organ failure, and mortality in pediatric intensive care. AU - Yung,Michael, AU - Wilkins,Barry, AU - Norton,Lynda, AU - Slater,Anthony, AU - ,, AU - ,, PY - 2008/5/15/pubmed PY - 2008/7/9/medline PY - 2008/5/15/entrez SP - 147 EP - 52 JF - Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies JO - Pediatr Crit Care Med VL - 9 IS - 2 N2 - OBJECTIVE: In ventilated children, to determine the prevalence of hyperglycemia, establish whether it is associated with organ failure, and document glycemic control practices in Australasian pediatric intensive care units (PICUs). DESIGN: Prospective inception cohort study. SETTING: All nine specialist PICUs in Australia and New Zealand. PATIENTS: Children ventilated > 12 hrs excluding those with diabetic ketoacidosis, on home ventilation, undergoing active cardiopulmonary resuscitation on admission, or with do-not-resuscitate orders. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: All blood glucose measurements for up to 14 days, clinical and laboratory values needed to calculate Paediatric Logistic Organ Dysfunction (PELOD) scores, and insulin use were recorded in 409 patients. Fifty percent of glucose measurements were > 6.1 mmol/L, with 89% of patients having peak values > 6.1 mmol/L. The median time to peak blood glucose was 7 hrs. Hyperglycemia was defined by area under the glucose-time curve > 6.1 mmol/L above the sample median. Thirteen percent of hyperglycemic subjects died vs. 3% of nonhyperglycemic subjects. There was an independent association between hyperglycemia and a PELOD score > or = 10 (odds ratio 3.41, 95% confidence interval 1.91-6.10) and death (odds ratio 3.31, 95% confidence interval 1.26-7.7). Early hyperglycemia, defined using only glucose data in the first 48 hrs, was also associated with these outcomes but not with PELOD > or = 10 after day 2 or with worsening PELOD after day 1. Five percent of patients received insulin. CONCLUSIONS: Hyperglycemia is common in PICUs, occurs early, and is independently associated with organ failure and death. However, early hyperglycemia is not associated with later or worsening organ failure. Australasian PICUs seldom use insulin. SN - 1529-7535 UR - https://www.unboundmedicine.com/medline/citation/18477927/Glucose_control_organ_failure_and_mortality_in_pediatric_intensive_care_ L2 - https://doi.org/10.1097/PCC.0b013e3181668c22 DB - PRIME DP - Unbound Medicine ER -