Tags

Type your tag names separated by a space and hit enter

Management of hyperglycemia in the pediatric intensive care unit; implementation of a glucose control protocol.
Pediatr Crit Care Med. 2009 Nov; 10(6):648-52.PC

Abstract

OBJECTIVE

To evaluate a stepwise nurse-driven glucose control protocol for the treatment of hyperglycemia in critically ill pediatric patients.

SETTING

Academic pediatric intensive care unit.

DESIGN

Prospective observational study.

PATIENTS

A total of 50 consecutively admitted critically ill children with hyperglycemia >8 mmol/L (>145 mg/dL) were included and treated according to the glucose control protocol.

MEASUREMENTS AND MAIN RESULTS

Demographic data and clinical parameters were collected and different steps in the protocol were evaluated. Data were expressed as medians with interquartile ranges. Fifty children (28 boys), aged 3.5 yrs (range, 1.2 -9.3 yrs) were treated in 18 mos. Forty-two children had multiple organ failure. Eight children died. Insulin treatment was initiated 4 hrs after the first episode of hyperglycemia was documented (median blood glucose, 11.4 mmol/L, [207 mg/dL] [9.7-14.5 mmol/L, 176-264 mg/dL]). Blood glucose was <8 mmol/L (<145 mg/dL) within 12 hrs of initiating insulin therapy in 47 (94%) of 50 children (median, 5 hrs). Duration of treatment was 34 hrs (17-72 hrs) and the maximum insulin dose ranged between 20 and 200 mIU/kg/hr (median, 70 mIU/kg/hr). Episodes of severe hypoglycemia <2.2 mmol/L (<47 mg/dL) did not occur.

CONCLUSION

The use of a stepwise nurse-driven glucose control protocol resulted in normoglycemia within 12 hrs for 94% of the children involved. Episodes of severe hypoglycemia did not occur. We conclude that the glucose control protocol is effective in treating hyperglycemia in critically ill children. Further studies are necessary to assess safety before the protocol could also be implemented in other pediatric intensive care units.

Authors+Show Affiliations

Intensive Care, Erasmus MC-Sophia Children's Hospital Rotterdam, Rotterdam, The Netherlands.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

19602994

Citation

Verhoeven, Jennifer J., et al. "Management of Hyperglycemia in the Pediatric Intensive Care Unit; Implementation of a Glucose Control Protocol." 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. 10, no. 6, 2009, pp. 648-52.
Verhoeven JJ, Brand JB, van de Polder MM, et al. Management of hyperglycemia in the pediatric intensive care unit; implementation of a glucose control protocol. Pediatr Crit Care Med. 2009;10(6):648-52.
Verhoeven, J. J., Brand, J. B., van de Polder, M. M., & Joosten, K. F. (2009). Management of hyperglycemia in the pediatric intensive care unit; implementation of a glucose control protocol. Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 10(6), 648-52. https://doi.org/10.1097/PCC.0b013e3181ae787b
Verhoeven JJ, et al. Management of Hyperglycemia in the Pediatric Intensive Care Unit; Implementation of a Glucose Control Protocol. Pediatr Crit Care Med. 2009;10(6):648-52. PubMed PMID: 19602994.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Management of hyperglycemia in the pediatric intensive care unit; implementation of a glucose control protocol. AU - Verhoeven,Jennifer J, AU - Brand,Jeannette B, AU - van de Polder,Mirjam M, AU - Joosten,Koen F M, PY - 2009/7/16/entrez PY - 2009/7/16/pubmed PY - 2010/1/27/medline SP - 648 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 - 10 IS - 6 N2 - OBJECTIVE: To evaluate a stepwise nurse-driven glucose control protocol for the treatment of hyperglycemia in critically ill pediatric patients. SETTING: Academic pediatric intensive care unit. DESIGN: Prospective observational study. PATIENTS: A total of 50 consecutively admitted critically ill children with hyperglycemia >8 mmol/L (>145 mg/dL) were included and treated according to the glucose control protocol. MEASUREMENTS AND MAIN RESULTS: Demographic data and clinical parameters were collected and different steps in the protocol were evaluated. Data were expressed as medians with interquartile ranges. Fifty children (28 boys), aged 3.5 yrs (range, 1.2 -9.3 yrs) were treated in 18 mos. Forty-two children had multiple organ failure. Eight children died. Insulin treatment was initiated 4 hrs after the first episode of hyperglycemia was documented (median blood glucose, 11.4 mmol/L, [207 mg/dL] [9.7-14.5 mmol/L, 176-264 mg/dL]). Blood glucose was <8 mmol/L (<145 mg/dL) within 12 hrs of initiating insulin therapy in 47 (94%) of 50 children (median, 5 hrs). Duration of treatment was 34 hrs (17-72 hrs) and the maximum insulin dose ranged between 20 and 200 mIU/kg/hr (median, 70 mIU/kg/hr). Episodes of severe hypoglycemia <2.2 mmol/L (<47 mg/dL) did not occur. CONCLUSION: The use of a stepwise nurse-driven glucose control protocol resulted in normoglycemia within 12 hrs for 94% of the children involved. Episodes of severe hypoglycemia did not occur. We conclude that the glucose control protocol is effective in treating hyperglycemia in critically ill children. Further studies are necessary to assess safety before the protocol could also be implemented in other pediatric intensive care units. SN - 1529-7535 UR - https://www.unboundmedicine.com/medline/citation/19602994/Management_of_hyperglycemia_in_the_pediatric_intensive_care_unit L2 - http://Insights.ovid.com/pubmed?pmid=19602994 DB - PRIME DP - Unbound Medicine ER -